• Bastian Pass, Denis Sieben, Fahd Malek, Bjoern Hussmann, Teresa Maek, Rene Aigner, Christopher Bliemel, Daniel Dirkmann, Sven Lendemans, and Carsten Schoeneberg.
• Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
• Eur J Trauma Emerg Surg. 2023 Dec 1; 49 (6): 248524932485-2493.

PurposeFractures of the proximal femur in geriatric patients are life-changing and life-threatening events. Previous research has identified fluid volume as an independent factor contributing to trauma patients' complications. Therefore, we aimed to investigate the impact of intraoperative fluid volume on outcomes in geriatric patients undergoing hip fracture surgery.MethodsWe conducted a retrospective single-center study with data from the hospital information systems. Our study included patients aged 70 years or older who had sustained a proximal femur fracture. We excluded patients with pathologic, periprosthetic, or peri-implant fractures and those with missing data. Based on the fluids given, we divided patients into high-volume and low-volume groups.ResultsPatients with a higher American Society of Anesthesiologists (ASA) grade and more comorbidities were more likely to receive more than 1500 ml of fluids. We observed significant differences in anesthesiologic management between the two groups, with a higher rate of invasive blood pressure management (IBP) and central venous catheter usage in the high-volume group. High-volume therapy was associated with a higher rate of complications (69.7% vs. 43.6%, p < 0.01), a higher transfusion rate (odds ratio 1.91 [1.26-2.91]), and an increased likelihood of patients being transferred to an intensive care unit (17.1% vs. 6.4%, p = 0.009). These findings were confirmed after adjusting for ASA grade, age, sex, type of fracture, Identification-of-Seniors-At-Risk (ISAR) score, and intraoperative blood loss.ConclusionsOur study suggests that intraoperative fluid volume is a significant factor that impacts the outcome of hip fracture surgery in geriatric patients. High-volume therapy was associated with increased complications.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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