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BACKGROUND: Proximal femoral nail anti-rotation is widely used in the treatment of elderly patients with femoral intertrochanteric fracture. Its surgical injury is small and the fixation is reliable, but the perioperative blood loss is still large. The proportion of patients who need blood transfusion after operation is still high, which has been bothering orthopedic surgeons. OBJECTIVE: To explore the related risk factors of blood transfusion after proximal femoral nail anti-rotation fixation of femoral intertrochanteric fracture in the elderly, and to establish and verify a nomogram prediction model to provide guidance for early identification of postoperative high-risk blood transfusion patients. METHODS: The perioperative clinical data of patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation in the Department of Traumatic Orthopedics of Subei People’s Hospital of Jiangsu Province from January 2016 to December 2020 were analyzed retrospectively. According to whether the patients received blood transfusion or not, the patients were divided into transfusion group and non-transfusion group. Univariate and multivariate Logistic regression analyses were performed to explore the independent risk factors for postoperative blood transfusion. According to the results of multiple factors, a nomogram prediction model was established, and the ROC curve and calibration curve were drawn to evaluate the prediction performance and consistency. RESULTS AND CONCLUSION: (1) Totally 366 patients were included in the study, with 142 patients in the transfusion group, and the probability of postoperative blood transfusion was 38.8%. (2) Univariate analysis showed that age, type of fracture, preoperative hemoglobin, preoperative albumin, time from injury to operation, type of anesthesia and intraoperative blood loss were related to postoperative blood transfusion (P < 0.05). (3) Multivariate Logistic regression analysis showed that fracture type, preoperative albumin, preoperative hemoglobin and intraoperative blood loss were independent risk factors for blood transfusion (all P < 0.05). (4) The ROC curve showed that the area under the curve for predicting the risk of postoperative blood transfusion by the model was 0.95, and the slope of the calibration curve was close to 1, indicating that the model had good differentiation and accuracy. (5) The prediction model of postoperative blood transfusion in elderly patients with femoral intertrochanteric fracture based on the results of multivariate Logistic analysis can provide scientific guidance for clinical orthopedic surgeons and further ensure the perioperative safety of such patients. [ABSTRACT FROM AUTHOR]