Low Calcium Levels May increase transfusion need, Worsen Surgical Outcomes in Elderly Hip Fracture Patients, Study Finds

“Patients with hypocalcemia recorded greater blood loss on both the first (714.91 ml vs. 640.31 ml) and fifth (1035.87 ml vs. 859.92 ml) postoperative days compared to those with normal calcium levels,” the researchers reported in BMC Surgery. They further noted that these patients also had higher transfusion rates, suggesting that timely correction of calcium levels may help reduce such complications and improve surgical outcomes.

Hip fractures in the elderly are already associated with high morbidity and mortality, making effective perioperative management crucial. The researchers note that the added burden of hypocalcemia, often overlooked in routine assessments, could worsen patient outcomes by increasing complications related to excessive blood loss and transfusion, such as infections, delayed recovery, and longer hospital stays. Shilong Su, Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, China, and colleagues aimed to investigate the impact of hypocalcemia on total blood loss and the need for blood transfusion in elderly patients undergoing surgery for hip fracture.

For this purpose, the researchers included elderly patients with hip fractures who underwent surgery at their hospital between January 2020 and May 2023. They collected and analyzed data on demographics, perioperative parameters, hemoglobin and hematocrit levels, and transfusion requirements. Hypocalcemia was defined as an albumin-corrected calcium level below 2.15 mmol/L. Total blood loss was calculated for each patient using the Nadler and Gross formulas, while blood loss on the first and fifth postoperative days was also assessed.

Key Findings:

• The study included a total of 682 elderly patients with hip fractures.
• The prevalence of hypocalcemia on admission was 40.47%.
• Total blood loss on the first postoperative day was significantly higher in the hypocalcemia group compared to the normocalcemia group (714.91 ± 396.05 ml vs. 640.31 ± 398.83 ml).
• On the fifth postoperative day, total blood loss remained higher among hypocalcemia patients (1035.87 ± 528.77 ml vs. 859.92 ± 434.99 ml).
• Patients with hypocalcemia showed higher rates of preoperative, postoperative, and perioperative blood transfusion than those with normal calcium levels.

The study concluded that hypocalcemia significantly contributed to greater total blood loss and higher blood transfusion requirements in elderly patients undergoing hip fracture surgery, highlighting the importance of monitoring and managing calcium levels to improve perioperative outcomes.

Reference:

Zhang, Y., Lu, K., Liu, Q. et al. Hypocalcemia was associated with increased perioperative blood loss and blood transfusion in elderly patients with hip fracture: a retrospective study. BMC Surg 25, 134 (2025). https://doi.org/10.1186/s12893-025-02872-2