Impact of Preoperative Waiting Time on Intraoperative Blood Transfusion in Older Patients with Hip Fracture: A Retrospective Cohort Study

Objective: To explore the associations of preoperative waiting time with the incidence of intraoperative blood transfusion and transfusion volume among older patients with hip fracture, to inform perioperative blood management and optimize surgical timing. Methods: Older patients aged ≥65 years who underwent hip fracture surgery at a tertiary trauma center in Northwest China between 1 January 2015 and 30 September 2019 were included. The primary exposure variable was preoperative waiting time. The outcome indicators included intraoperative transfusion status and total transfusion volume. Logistic regression was used for binary transfusion outcomes, and general linear regression was applied for continuous transfusion volume. Multivariate regression models were established to adjust for confounders after univariate screening, and stratified analyses were performed to explore population heterogeneity. Results: A total of 2836 eligible patients were included in this study. The mean age of all participants was 79.52 ± 6.68 years, including 2100 cases of intertrochanteric fracture and 736 cases of femoral neck fracture. Intraoperative blood transfusion was administered in 1415 patients (49.9%). Fully adjusted analyses revealed that each one-day increase in preoperative waiting time was associated with a 6% higher odds of intraoperative transfusion (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.02–1.10, p = 0.0007) and a 0.03-unit increase in transfusion volume (β = 0.03, 95%CI: 0.02–0.05, p < 0.0001). However, no independent association was observed for massive transfusion. The associations were generally consistent across strata despite apparent numerical differences (p for interaction tests > 0.05). Conclusions: Among older patients undergoing hip fracture surgery, longer waiting time was associated with higher transfusion risk. These findings highlight the critical importance of optimizing perioperative pathways to minimize surgical delays. Because residual confounding and inability to distinguish medical from administrative delay remain important limitations, these findings should be interpreted as an association rather than proof that surgical delay causes increased transfusion requirements.