Hidden blood loss and its risk factors after hip hemiarthroplasty for hip fracture in the elderly

Abstract

Objectives: This study aims to evaluate hidden blood loss (HBL) and its determinants in elderly hip fracture patients undergoing this procedure via a posterolateral approach.

Patients and methods: Between January 2016 and June 2024, a total of 105 patients (52 males, 53 females; mean age: 78.5±5.6 years; range, 60 to 93 years) who underwent hip hemiarthroplasty through a posterolateral approach were retrospectively analyzed. Patient demographics and clinical data were obtained. Pre- and postoperative hematocrit (Hct), height, and weight were documented. Perioperative total blood loss (TBL) and HBL were quantified using the Gross and Sehat formulas, respectively. Risk factors linked to HBL were determined.

Results: The mean operative duration was 80.3±9.9 min. The mean HBL was 465.9±58.3 mL, accounting for 81.4% of TBL (571.1±149.6 mL). Multivariate linear regression revealed significant associations between increased HBL and lower preoperative albumin (β=–0.188, p=0.011), higher American Society of Anesthesiologists (ASA) classification (β=0.162, p=0.029), and perioperative blood transfusion (β=0.221, p=0.002).

Conclusion: Hidden blood loss constitutes a clinically significant consideration during hip hemiarthroplasty for geriatric hip fractures. Significantly greater HBL occurs in patients with preoperative hypoalbuminemia, elevated ASA classification, or perioperative transfusion. Recognizing and quantifying HBL enhances perioperative assessment precision and contributes to improved patient safety.

Citation: Zeng JW, Chen X, Yang LM, Liu CJ, Cao F. Hidden blood loss and its risk factors after hip hemiarthroplasty for hip fracture in the elderly. Jt Dis Relat Surg 2026;37(1):35-41. doi: 10.52312/ jdrs.2026.2482.

Wrote the draft of the manuscript, was a major contributor in design and revising: J.WZ.; Critically reviewed and revised the manuscript for important intellectual content: F.C.; Were involved in collecting data and design of the study: X.C., L.M.Y., C.J.L. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

The data that support the findings of this study are available from the corresponding author upon reasonable request.