Choosing Wisely:

Don’t proceed with elective surgery in patients with properly diagnosed and correctable anemia until the anemia has been appropriately treated.

Rationale and Comments: Anemia is common, presenting in approximately one-third of patients undergoing elective surgery. There is often the misconception that anemia is harmless, when, in fact, it is independently associated with significant morbidity and mortality that can be as high as 30-40% in certain patient populations. Treatment of anemia improves patient readiness for surgery, aids in management of comorbid conditions, decreases length of stay and readmission rates, and reduces transfusion risks. Treatment modalities may include nutritional supplementations, such as iron, B12 and folate, changes in medication, management of chronic inflammatory conditions or previously undiagnosed malignancy, or other interventions based on the etiology.
Sponsoring Organizations:
  • Society for the Advancement of Blood Management
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • Surgical
  • References: • Mursallana KM, Tamim HM, Richards T, et al. Preoperative anaemia and post operative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396-4007.
    • Koch C, Li L, Sun Z, et al. Hospital-acquired anemia: prevalence, outcomes, and healthcare implications. J Hosp Med. 2013;8(9):506-512.
    • Beattie WS, Karkouti K, Wijeysundera DN, Tait G, et al. Risk associated with preoperative anemia in non-cardiac surgery; a single-center cohort study. Anesthesiology. 2009;110(3):574-581.
    • Munoz M, Acheson AG, Aurbach M, et al. International consensus on peri-operative anemia and iron deficiency. Anaesthesia. 2017;72:233-247.
    • Gombotz, Zacharowski, Spahn (eds.). Patient Blood Management. Thieme Publishers, 2016.

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