Preoperative anaemia in elective surgery with bleeding risk

Anaemia is associated with increased morbidity and mortality in surgical patients, but it is often a modifiable condition. International studies have reported a high prevalence of preoperative anaemia (30-40 %), particularly due to iron deficiency. This article aims to describe the prevalence of preoperative anaemia in a Norwegian surgical patient population, which includes urological, gynaecological, orthopaedic and gastrointestinal patients.

Adult patients undergoing elective surgery with a risk of > 500 mL blood loss at Bærum Hospital between 1 January and 30 June 2024 were included. Demographic and perioperative data were collected retrospectively and included surgical category, haemoglobin concentration, ferritin measurement, red blood cell transfusion and iron supplementation.

A total of 293 patients were included in the study. Preoperative anaemia (haemoglobin level < 13 g/dL) was identified in 99/293 patients (34 %). Ferritin was measured in 25/99 patients (25 %) with preoperative anaemia. Preoperative iron supplementation was administered to 27/99 patients (27 %) with anaemia. Overall, 29/293 patients (10 %) received red blood cell transfusions during the perioperative period.

The prevalence of preoperative anaemia in this surgical population is comparable to that reported in larger European studies. Ferritin measurement is part of the diagnostic evaluation and treatment stratification of anaemia. The low rate of preoperative ferritin testing suggests a potential for improvement in the preoperative optimisation of haemoglobin levels.