Development and Validation of a Nomogram for Predicting Perioperative Hidden Blood Loss in Intertrochanteric Femur Fractures

Abstract Background Hip fractures, prevalent in the elderly, carry significant morbidity and mortality, with perioperative hidden blood loss (HBL) being a critical yet underappreciated factor. The challenge of HBL in intertrochanteric femoral fractures treated with proximal femoral nail antirotation (PFNA) procedures necessitates a predictive tool for improved clinical management. Objectives To identify independent risk factors for perioperative HBL and to develop a predictive nomogram for intertrochanteric femoral fractures managed with PFNA. Methods We conducted a retrospective cohort study of 231 patients who underwent PFNA at Northern Jiangsu People’s Hospital from 2020 to 2022. Data on demographics and surgery were analyzed using SPSS 25.0 and R 4.2.2 to construct a nomogram predicting HBL. Results The study revealed a mean HBL of 1146.91 ± 727.35 ml. Significant predictors included preoperative hemoglobin, platelet count, PT-INR, fracture type by Evans classification, and the interval from admission to surgery. The predictive nomogram demonstrated high accuracy with an AUC of 0.926 for the ROC curve and 0.941 for the PR curve, indicating robust clinical utility. Conclusion The validated nomogram offers a novel, practical approach to forecasting HBL in patients undergoing PFNA for intertrochanteric femoral fractures, with implications for optimizing patient care across the perioperative period.