Preoperative and postoperative anemia in major
elective surgery: insights from a retrospective cohort in
a Brazilian University Hospital

Lorena dos Santos Goiabeira; Sara Silva Meireles; Allan Santos Silva Leocádio; Heitor J.S. Medeiros; Fernanda Cunha Soares; Aline Macedo Pinheiro; Wallace Andrino da Silva

doi:10.1016/j.bjane.2025.844715

Original Investigation

Preoperative and postoperative anemia in major elective surgery: insights from a retrospective cohort in a Brazilian University Hospital

Anemia pré-operatória e pós-operatória em cirurgias eletivas de grande porte: insights de uma coorte retrospectiva em um hospital universitário brasileiro

Lorena dos Santos Goiabeira, Sara Silva Meireles, Allan Santos Silva Leocádio, Heitor J.S. Medeiros, Fernanda Cunha Soares, Aline Macedo Pinheiro, Wallace Andrino da Silva

http://dx.doi.org/10.1016/j.bjane.2025.844715 Braz J Anesthesiol, vol.76, n2, 844715, 2025

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Abstract

Background

Anemia is a common and critical condition in the perioperative management of patients undergoing major elective surgeries, posing significant risks to postoperative recovery. This study aimed to evaluate the prevalence of preoperative and postoperative anemia in surgical patients from a university hospital in northeastern Brazil.

Methods

This retrospective study included 508 patients aged 18 years or older who underwent major elective surgeries between October 2021 and October 2022. Anemia was defined according to World Health Organization criteria (hemoglobin < 13 g.dL^-1 for men and < 12 g.dL^-1 for women). Data were extracted from medical records and included preoperative and postoperative hemoglobin levels, surgical types, and transfusion requirements.

Results

Preoperative anemia was observed in 59.6% of 508 patients analyzed, with a mean Hb level of 11.66 (± 2.75) g.dL^-1 and 11.13 (± 2.08) g.dL^-1 for women and men, respectively. In the postoperative period, the anemia rate increased to 94.6%, with a mean Hb level of 9.36 (± 1.55) g.dL^-1 and 9.49 (± 1.36) g.dL^-1 for women and men, respectively. The transfusion rate was 27% in the total sample. Patients with preoperative anemia were 4.6 times more likely to require intraoperative transfusion compared to non-anemic patients (OR = 4.58; 95% CI: 2.78–7.52; p < 0.001). Higher preoperative hemoglobin levels were identified as protective against transfusion (OR = 0.65; 95% CI: 0.59–0.72; p < 0.001).

Conclusions

Preoperative anemia is a highly prevalent and modifiable risk factor associated with increased transfusion requirements and adverse perioperative outcomes. The study highlights the importance of implementing patient blood management protocols in surgical practice.

Keywords

Anemia; Blood transfusion; Intraoperative period

Resumo

Introdução

A anemia é uma condição comum e crítica no manejo perioperatório de pacientes submetidos a cirurgias eletivas de grande porte, representando riscos significativos para a recuperação pós-operatória. Este estudo teve como objetivo avaliar a prevalência de anemia pré-operatória e pós-operatória em pacientes cirúrgicos de um hospital universitário no Nordeste do Brasil.

Métodos

Este estudo retrospectivo incluiu 508 pacientes com 18 anos ou mais submetidos a cirurgias eletivas de grande porte entre outubro de 2021 e outubro de 2022. A anemia foi definida de acordo com os critérios da Organização Mundial da Saúde (hemoglobina < 13 g.dL⁻¹ para homens e < 12 g.dL⁻¹ para mulheres). Os dados foram extraídos de prontuários médicos e incluíram níveis de hemoglobina no pré e pós-operatório, tipos de cirurgia e necessidade de transfusão.

Resultados

A anemia pré-operatória foi observada em 59,6% dos 508 pacientes analisados, com nível médio de Hb de 11,66 (± 2,75) g.dL⁻¹ para mulheres e 11,13 (± 2,08) g.dL⁻¹ para homens. No período pós-operatório, a taxa de anemia aumentou para 94,6%, com nível médio de Hb de 9,36 (± 1,55) g.dL⁻¹ para mulheres e 9,49 (± 1,36) g.dL⁻¹ para homens. A taxa de transfusão foi de 27% na amostra total. Pacientes com anemia pré-operatória apresentaram 4,6 vezes mais chance de necessitar de transfusão intraoperatória em comparação com pacientes não anêmicos (OR = 4,58; IC 95%: 2,78–7,52; p < 0,001). Níveis mais elevados de hemoglobina no pré-operatório foram identificados como fator protetor contra transfusão (OR = 0,65; IC 95%: 0,59–0,72; p < 0,001).

Conclusão

A anemia pré-operatória é um fator de risco altamente prevalente e modificável, associado ao aumento da necessidade de transfusão e a desfechos perioperatórios adversos. O estudo destaca a importância da implementação de protocolos de gerenciamento de sangue do paciente (Patient Blood Management – PBM) na prática cirúrgica.

Palavras-chave

Anemia; Transfusão de sangue; Período intraoperatório

References

1. Kalra SK, Thilagar B, Khambaty M, Manjarrez E. Post-operative Anemia After Major Surgery: a Brief Review. Curr Emerg Hosp Med Rep. 2021;9:89−95.

2. Gomez-Ramirez S, Jericó C, Muñoz M. Perioperative anemia: Prevalence, consequences and pathophysiology. Transfus Apher Sci. 2019;58:369−74.

3. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 2015;102:1314−24.

4. Macedo MCMA, Biagini S, Montano-Pedroso JC, et al. Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Implementation of Patient Blood Management (PBM). Hematol Transfus Cell Ther. 2024;46:8−11.

5. World Health Organization. WHO guidelines for safe surgery 2009: safe surgery saves lives. Geneva: World Health Organization; 2009. Available from https://iris.who.int/handle/10665/ 44185.

6. World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. Available from https://www.who. int/publications/i/item/9789240088542.

7. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396−407.

8. Beattie WS, Karkouti K, Wijeysundera DN, Tait G. Risk Associated with Preoperative Anemia in Noncardiac Surgery: A Singlecenter Cohort Study. Anesthesiology. 2009;110:574.

9. Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G. Major Bleeding, Transfusions, and Anemia: The Deadly Triad of Cardiac Surgery. Ann Thorac Surg. 2013;96:478−85.

10. Mendanha C, Neto PCS, Borges RB, et al. The burden of preoperative anaemia and postoperative outcomes in 15 166 surgical patients from a public hospital in Brazil: A retrospective cohort study. Eur J Anaesthesiol. 2025;42:44.

11. Duarte GC, Ribeiro GN, Moschen M, Toledo RSM, Bordin JO, Langhi DM. Targeting patient blood management’s first pillar: A multicentric retrospective study on preoperative anemia. Hematol Transfus Cell Ther. 2023;45:338−41.

12. Hazen YJJM, Noordzij PG, Gerritse BM, et al. Preoperative anaemia and outcome after elective cardiac surgery: a Dutch national registry analysis. Br J Anaesth. 2022;128:636−43.

13. Cappellini MD, Comin-Colet J, de Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92:1068−78.

14. Richards T, Baikady RR, Clevenger B, et al. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomized, double-blind, controlled trial. Lancet Lond Engl. 2020;396:1353−61.

15. Munoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72:233−47.

16. Shander A, Corwin HL, Meier J, et al. Recommendations From the International Consensus Conference on Anemia Management in Surgical Patients (ICCAMS). Ann Surg. 2023;277:581−90.

Submitted date:
04/14/2025

Accepted date:
11/16/2025