Perioperative Bleeding Risk and Associated Factors in End-Stage Kidney Disease Patients Undergoing Intertrochanteric Fracture Surgery: Implications for Management.

BACKGROUND

End-stage renal disease (ESRD) patients undergoing intertrochanteric fracture surgery face complex coagulation challenges. This study aimed to identify risk factors for coagulation dysfunction in ESRD patients during the perioperative period of intertrochanteric fracture surgery.

METHODS

This retrospective study included 127 patients who underwent surgical treatment for intertrochanteric femoral fractures between January 2019 and June 2023, of whom 33 had end-stage renal disease (ESRD) and were receiving maintenance dialysis. Propensity score matching was performed at a 1:1 ratio based on age, gender, BMI (body mass index), fracture classification, anesthesia type, and APACHE II score, yielding 33 matched non-ESRD controls. Perioperative data, including coagulation parameters, biochemical indices, and clinical outcomes, were collected. Multivariable regression analysis was conducted to identify risk factors associated with coagulation dysfunction.

RESULTS

The dialysis group showed significantly different coagulation profiles compared to controls, particularly in platelet count (71.6 ± 21.3 vs 159.1 ± 35.7×109/L, P = 0.003) and blood loss (609.9 ± 89.2 vs 559.3 ± 55.5 mL, P = 0.007). Regression analysis revealed that blood loss in the dialysis group was primarily influenced by platelet count (P < 0.001) and anticoagulant dose (P < 0.001), while in the control group it was mainly affected by surgery duration (P < 0.001). Although mean surgery duration did not differ significantly between groups, its relationship with blood loss varied markedly between ESRD and non-ESRD patients. The dialysis group experienced more complications, with most bleeding events occurring 5-7 days postoperatively when platelet counts reached their nadir.

CONCLUSION

ESRD patients face increased bleeding risk during intertrochanteric fracture surgery, primarily associated with platelet count and anticoagulant use. The critical period for bleeding complications occurs 5-7 days postoperatively, suggesting the need for careful platelet monitoring and individualized anticoagulation protocols during this timeframe.