{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:13:25Z","timestamp":1786979605823,"version":"build-2736575974"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T00:00:00Z","timestamp":1662940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Blood loss after proximal femoral fractures is an important risk factor for postoperative outcome and recovery. The purpose of our study was to investigate the total blood loss depending on fracture type and additional risks, such as anticoagulant use, to be able to recognize vulnerable patients depending on planned surgery and underlying comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A retrospective single center study including 1478 patients treated operatively for a proximal femoral fracture between January 2016 and June 2020 at a level I trauma center. Patient data, surgical procedure, time to surgery, complications and mortality were assessed. Lab data including hemoglobin and transfusion rates were collected. The Mercuriali formula was implemented to calculate total blood loss. Linear regression was performed to identify influencing factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One thousand four hundred seventy-eight mainly female patients were included in the study (mean age: 79.8\u00a0years) comprising 667 femoral neck fractures, 704 pertrochanteric- and 107 subtrochanteric fractures. Nearly 50% of the cohort were on anticoagulants or anti- platelet therapy. At time of admission average hemoglobin was 12.1\u00a0g\/l. Linear regression proved fracture morphology, age, BMI, in-house mortality and anticoagulant use to have crucial influence on postoperative blood loss. Femoral neck fractures had a blood loss of 1227.5\u00a0ml (SD 740.4\u00a0ml), pertrochanteric fractures lost 1,474.2\u00a0ml (SD 830\u00a0ml) and subtrochanteric femoral fractures lost 1902.2\u00a0ml (SD 1,058\u00a0ml).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hidden blood loss is underestimated. Anticoagulant use, fracture type, gender and BMI influence the total blood loss. Hemoglobin levels should be monitored closely. Within 48\u00a0h there was no increased mortality, so adequate time should be given to reduce anticoagulant levels and safely perform surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-022-02090-y","type":"journal-article","created":{"date-parts":[[2022,9,12]],"date-time":"2022-09-12T12:07:39Z","timestamp":1662984459000},"page":"173-179","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Anticoagulants and fracture morphology have a significant influence on total blood loss after proximal femur fractures"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-3326","authenticated-orcid":false,"given":"Annabel","family":"Fenwick","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Pfann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iana","family":"Antonovska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Wiedl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Feldmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Nuber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"F\u00f6rch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"issue":"1 Suppl","key":"2090_CR1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/8756-3282(95)00381-9","volume":"18","author":"P Kannus","year":"1996","unstructured":"Kannus P, Parkkari J, Sievanen H, et al. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl):57\u201363.","journal-title":"Bone"},{"issue":"3 Suppl","key":"2090_CR2","doi-asserted-by":"publisher","first-page":"121S","DOI":"10.1016\/8756-3282(95)00492-0","volume":"18","author":"LJ Melton 3rd","year":"1996","unstructured":"Melton LJ 3rd. Epidemiology of hip fractures: implications of the exponential increase with age. Bone. 1996;18(3 Suppl):121S-125S. https:\/\/doi.org\/10.1016\/8756-3282(95)00492-0.","journal-title":"Bone"},{"key":"2090_CR3","doi-asserted-by":"publisher","first-page":"665","DOI":"10.3238\/arztebl.m2021.0238","volume":"118","author":"M Rupp","year":"2021","unstructured":"Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, Baumann F, Alt V. The incidence of fractures among the adult population of Germany\u2014an analysis from 2009 through 2019. Dtsch Arztebl Int. 2021;118:665\u20139. https:\/\/doi.org\/10.3238\/arztebl.m2021.0238.","journal-title":"Dtsch Arztebl Int"},{"key":"2090_CR4","unstructured":"Canale ST, Beaty JH. Campbell\u2019s operative orthopaedics. 11th ed. Mosby Elsevier Masson; 2007."},{"key":"2090_CR5","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S0968-0160(00)00047-8","volume":"7","author":"KR Sehat","year":"2000","unstructured":"Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee. 2000;7:151\u20135.","journal-title":"Knee"},{"issue":"7","key":"2090_CR6","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1016\/j.arth.2010.11.013","volume":"26","author":"X Liu","year":"2011","unstructured":"Liu X, Zhang X, et al. Hidden blood loss after total hip arthroplasty. J Arthoplasty. 2011;26(7):1100-5.e1. https:\/\/doi.org\/10.1016\/j.arth.2010.11.013.","journal-title":"J Arthoplasty."},{"key":"2090_CR7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13018-015-0185-9","volume":"10","author":"K Miao","year":"2015","unstructured":"Miao K, Ni S, et al. Hidden blood loss and its influential factors after total hip arthroplasty. J Orthop Surg Res. 2015;10:36.","journal-title":"J Orthop Surg Res"},{"key":"2090_CR8","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1302\/0301-620X.88B8.17534","volume":"88B","author":"NB Foss","year":"2006","unstructured":"Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Jt Surg [Br]. 2006;88B:1053\u20139.","journal-title":"J Bone Jt Surg [Br]"},{"key":"2090_CR9","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1046\/j.0041-1132.2003.00581.x","volume":"43","author":"VA Lawrence","year":"2003","unstructured":"Lawrence VA, Silverstein JH, Cornell JE, et al. Higher Hb level is associated with better early functional recovery after hip fracture repair. Transfusion. 2003;43:1717\u201322.","journal-title":"Transfusion"},{"issue":"2","key":"2090_CR10","doi-asserted-by":"publisher","first-page":"p173","DOI":"10.1093\/ageing\/afm161","volume":"37","author":"NB Foss","year":"2008","unstructured":"Foss NB, Kristensen MT, Kehlet H. Anaemia impedes functional mobility after hip fracture surgery. Age Ageing. 2008;37(2):p173-178.","journal-title":"Age Ageing"},{"key":"2090_CR11","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jor.2016.10.019","volume":"14","author":"B Budair","year":"2017","unstructured":"Budair B, Ahmed U, Hodson J, et al. Are we all guilty of under-estimating intra-operative blood loss during hip fracture surgery? J Orthop. 2017;14:81\u20134. https:\/\/doi.org\/10.1016\/j.jor.2016.10.019.","journal-title":"J Orthop"},{"key":"2090_CR12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12891-020-03922-x","volume":"22","author":"H Cui","year":"2021","unstructured":"Cui H, Chen K, Lv S, et al. An analysis of perioperative hidden blood loss in femoral intertrochanteric fractures: bone density is an important influencing factor. BMC Musculoskelet Disord. 2021;22:6. https:\/\/doi.org\/10.1186\/s12891-020-03922-x.","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"2090_CR13","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1097\/00005131-200407000-00007","volume":"18","author":"EA Halm","year":"2004","unstructured":"Halm EA, Wang JJ, Boockvar K, et al. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma. 2004;18(6):369\u201374.","journal-title":"J Orthop Trauma"},{"key":"2090_CR14","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.injury.2010.07.239","volume":"42","author":"D Kumar","year":"2011","unstructured":"Kumar D, Mbako AN, Riddick A, Patil S, Williams P. On admission haemoglobin in patients with hip fracture. Injury. 2011;42:167\u201370.","journal-title":"Injury"},{"issue":"8","key":"2090_CR15","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1185\/03007999609115227","volume":"13","author":"F Mercuriali","year":"1996","unstructured":"Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin. 1996;13(8):465. https:\/\/doi.org\/10.1185\/03007999609115227 (Accepted 11 Sep 1996, Published online: 12 Aug 2008).","journal-title":"Curr Med Res Opin"},{"issue":"2","key":"2090_CR16","first-page":"224","volume":"51","author":"SB Nadler","year":"1962","unstructured":"Nadler SB, Hidalgo JH. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224\u201332 (Ted Bloch PMID: 21936146).","journal-title":"Surgery"},{"issue":"Suppl 3","key":"2090_CR17","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1016\/S0020-1383(17)30657-5","volume":"48","author":"M Ronga","year":"2017","unstructured":"Ronga M, et al. Blood loss in trochanteric fractures: multivariate analysis comparing dynamic hip screw and Gamma nail. Injury. 2017;48(Suppl 3):S44\u20137.","journal-title":"Injury"},{"key":"2090_CR18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1186\/s12891-016-1333-z","volume":"17","author":"L Cai","year":"2016","unstructured":"Cai L, Wang T, Di L, Hu W, Wang J. Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss. BMC Musculoskelet Disord. 2016;17:475. https:\/\/doi.org\/10.1186\/s12891-016-1333-z.","journal-title":"BMC Musculoskelet Disord"},{"key":"2090_CR19","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.jcot.2021.02.012","volume":"16","author":"J Stacey","year":"2021","unstructured":"Stacey J, Bush C, DiPasquale T. The hidden blood loss in proximal femur fractures is sizeable and Significant. J Clin Orthop Trauma. 2021;16:239\u201343.","journal-title":"J Clin Orthop Trauma"},{"key":"2090_CR20","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1186\/s12891-020-03208-2","volume":"21","author":"PH Lin","year":"2020","unstructured":"Lin PH, Chien JT, Hung JP, et al. Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study. BMC Musculoskelet Disord. 2020;21:244.","journal-title":"BMC Musculoskelet Disord"},{"key":"2090_CR21","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s00776-014-0667-3","volume":"20","author":"J Wang","year":"2015","unstructured":"Wang J, Wei J, Wang M. The risk factors of perioperative hemoglobin and hematocrit drop after intramedullary nailing treatment for intertrochanteric fracture patients. J Orthop Sci. 2015;20:163\u20137.","journal-title":"J Orthop Sci"},{"issue":"2 Suppl","key":"2090_CR22","doi-asserted-by":"publisher","first-page":"e44S","DOI":"10.1378\/chest.11-2292","volume":"141","author":"W Ageno","year":"2012","unstructured":"Ageno W, et al. Oral anticoagulant therapy antithrombotic therapy and prevention of thrombosis, 9th ed: American College Of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e44S-88S. https:\/\/doi.org\/10.1378\/chest.11-2292.","journal-title":"Chest"},{"issue":"2","key":"2090_CR23","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.injury.2010.02.015","volume":"42","author":"GH Smith","year":"2011","unstructured":"Smith GH, Tsang J, Molyneux SG, White TO. The hidden blood loss after hip fracture. Injury. 2011;42(2):133\u20135. https:\/\/doi.org\/10.1016\/j.injury.2010.02.015.","journal-title":"Injury"},{"key":"2090_CR24","doi-asserted-by":"publisher","first-page":"475","DOI":"10.2147\/CIA.S301737","volume":"16","author":"J Guo","year":"2021","unstructured":"Guo J, ZhangY HZ. Intramedullary fixation does not cause a large amount of hidden blood loss in elderly patients with intertrochanteric fractures. Clin Interv Aging. 2021;16:475\u201386.","journal-title":"Clin Interv Aging"},{"key":"2090_CR25","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.2147\/CIA.S174196","volume":"13","author":"WJ Gua","year":"2018","unstructured":"Gua WJ, Wang J, Zhang W, Wang W, et al. Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures: a cross-sectional study. Clin Interv Aging. 2018;13:1639\u201345.","journal-title":"Clin Interv Aging"},{"issue":"11","key":"2090_CR26","doi-asserted-by":"publisher","first-page":"2040","DOI":"10.1016\/j.injury.2019.09.011","volume":"50","author":"K Schuetze","year":"2019","unstructured":"Schuetze K, Eickhoff A, et al. Impact of oral anticoagulation on proximal femur fractures treated within 24 h\u2014a retrospective chart review. Injury. 2019;50(11):2040\u20134. https:\/\/doi.org\/10.1016\/j.injury.2019.09.011.","journal-title":"Injury"},{"issue":"4","key":"2090_CR27","doi-asserted-by":"publisher","first-page":"619","DOI":"10.5811\/westjem.2019.4.41649","volume":"20","author":"M Maguire","year":"2019","unstructured":"Maguire M, Fuh L, et al. Thromboembolic risk of 4-factor prothrombin complex concentrate versus fresh frozen plasma for urgent warfarin reversal in the emergency department. West J Emerg Med. 2019;20(4):619\u201325. https:\/\/doi.org\/10.5811\/westjem.2019.4.41649 (Published online 2019 Jun 11).","journal-title":"West J Emerg Med"},{"key":"2090_CR28","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1186\/s12891-021-04375-6","volume":"22","author":"T Haider","year":"2021","unstructured":"Haider T, Seilern JA, Gahleitner C, et al. Does patient positioning influence blood loss and transfusion rate in hip replacement for femoral neck fractures? A single-centre, retrospective chart review. BMC Musculoskelet Disord. 2021;22:496. https:\/\/doi.org\/10.1186\/s12891-021-04375-6.","journal-title":"BMC Musculoskelet Disord"},{"issue":"4","key":"2090_CR29","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1177\/2151458517729615","volume":"8","author":"KD Harper","year":"2017","unstructured":"Harper KD, Navo P, Ramsey F, Jallow S, Rehman S. \u201cHidden\u201d preoperative blood loss with extracapsular versus intracapsular hip fractures: what is the difference? Geriatr Orthop Surg Rehabil. 2017;8(4):202\u20137.","journal-title":"Geriatr Orthop Surg Rehabil."},{"key":"2090_CR30","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s13018-017-0625-9","volume":"12","author":"JL Lei","year":"2017","unstructured":"Lei JL, Zhang BZ, et al. Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial. J Orthop Surg Res. 2017;12:124. https:\/\/doi.org\/10.1186\/s13018-017-0625-9.","journal-title":"J Orthop Surg Res"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-02090-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-022-02090-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-02090-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T20:26:59Z","timestamp":1676320019000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-022-02090-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,12]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["2090"],"URL":"https:\/\/doi.org\/10.1007\/s00068-022-02090-y","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,12]]},"assertion":[{"value":"3 April 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Annabel Fenwick, Iana Antonovska, Michael Pfann, Jakob Mayr, Andreas Wiedl, Malte Feldmann, Stefan F\u00f6rch, Stefan Nuber and Edgar Mayr declare that they have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"We declare that the study has been performed in accordance with the Declaration of Helsinki and has been approved by the ethical Committee of the University of Augsburg.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}