[Objective] To analyze the risk factors of postoperative blood transfusion of femoral intertrochanteric fracture in the elderly, and an established prediction equation was verified. [Methods] A retrospective study was done on 358 elderly patients who received surgi- cal treatment for femoral intertrochanteric fractures in our hospital from December 2016 to December 2021. The patients were divided into transfusion group and non-transfusion group according to whether postoperative blood transfusion occurred. The univariate comparisons and multi-factor binary logistic regression analysis were conducted to search the relative factors, and then a prediction model was estab- lished with its efficiency evaluated. [Results] Among the 358 patients, 168 (46.9%) received postoperative blood transfusion. In term of uni- variate comparison, the transfusion group were significantly older in age [(80.7±8.5) years vs (76.6±8.7) years, P＜0.001], lower BMI [(20.7± 3.3) kg/m² vs (21.5±3.7) kg/m² , P=0.015], higher prevalence of hypertension [(105/63) vs (93/97), P=0.010], and more severe fracture types [A1/A2/A3, (40/93/35) vs (80/83/27), P＜0.001], longer operation time [(122.9±56.6) min vs (101.4±30.5) min, P＜0.001], more intraopera- tive blood loss [(258.3±218.9) ml vs (130.5±94.9) ml, P＜0.001], lower preoperative Hb [(93.1±14.8) g/L vs (111.6±14.2) g/L, P＜0.001], and lower preoperative Alb [(34.7±8.2) g/L vs (36.8±4.5) g/L, P=0.002] than the non-transfusion group, and all abovesaid were statistically sig- nificant between the two groups. As results of logistic regression analysis, the age (OR=1.053, P=0.007), operation time (OR=1.008, P= 0.025), intraoperative blood loss (OR=1.007, P＜0.001) were the independent risk factors for postoperative transfusion, while the BMI (OR= 0.900, P=0.025) and preoperative hemoglobin (OR=0.904, P＜0.001) were the independent protective factor. Based on the logistic regres- sion results, a prediction equation was established, which proved area under curve (AUC) of 0.894, 95%CI 0.862~0.927，with cutoff of 0.578, the sensitivity of 74.4%, and the specificity of 88.4% by the ROC analysis. [Conclusion] The advanced age, longer operation time,more intraoperative bleeding, lower BMI and lower hemoglobin are independent risk factors for postoperative blood transfusion. The predic- tion model of postoperative blood transfusion might be helpful to judge the risk of transfusion and prevent it in advance.