Objective To study the risk factors for perioperative heart failure in the elderly patients with femoral intertrochanteric fracture so as to provide guide information for prevention of the perioperative heart failure.Methods Included in this retrospective study were 175 elderly patients with femoral intertrochanteric fracture who had undergone closed reduction and intramedullary nail fixation in our hospital from May 2013 to August 2016.They were divided into 2 groups.In the heart failure group of 31 cases,there were 12 males and 19 females,with an age of 73.5 ± 7.8 years;in the non heart failure group of 144 cases,there were 61 males and 83 females,with an age of 69.8 ± 6.9 years.The 2 groups were compared in terms of age,early surgery,hypertension history,respiratory disease history,heart disease history,disturbance of consciousness,preoperative renal function,operation time,anesthesia method,operation time,perioperative fluid volume difference,perioperative pain score,and postoperative hemoglobin.After univariate analysis of these factors,the risk factors were determined through the multivariate regression analysis.Results The univariate analysis showed that age,heart disease history,perioperative fluid volume difference and perioperative pain score were statistically different between the 2 groups (P ＜ 0.05).By the multivariate analysis,the risk factors for perioperative heart failure were age [P =0.014,OR =1.063 (1.012,1.116)],heart disease history [P =0.008,OR =4.977 (1.526,16.230)],perioperative fluid volume difference [P =0.025,OR=2.421 (1.117,5.249)],and perioperativepain score [P=0.040,OR=2.292(1.040,5.050)].Conclusions Age,heart disease history,perioperative fluid volume difference and perioperative pain score may be the risk factors for perioperative heart failure in elderly patients with femoral intertrochanteric fracture.We should pay attention to these factors and evaluate their influences on the patient so as to take appropriate perioperative prevention and treatment measures to reduce the incidence of perioperative heart failure.