Perioperative Anemia Management in Patients Undergoing Gynaecologic Procedures: A 12-Year Multisite Study

OBJECTIVES: Perioperative anemia is a risk factor for adverse outcomes in surgery. The purpose of this study was to characterize perioperative red blood cell (RBC) transfusion and intravenous (IV) iron use in patients undergoing gynaecologic procedures. METHODS: This was a retrospective cohort study using data from a multihospital database in Ontario, Canada. Patients aged ≥15 years who underwent gynaecologic surgery with a hospital admission between April 1, 2010 and March 31, 2022 at 3 academic hospitals were identified. The primary outcomes were perioperative (90 days before to 30 days after surgery) RBC transfusion and IV iron utilization in patients undergoing gynaecologic surgery. Secondary outcomes included hospital length of stay, intensive care unit admission, and in-hospital mortality. RESULTS: Of the 5572 patients in our cohort, 27.6% had preoperative anemia and 18.7% received RBC transfusion during the perioperative period. A perioperative RBC transfusion was administered to 29.7% of patients with underlying malignancy and to 7.8% of patients without a diagnosis of malignancy. Of the 60 patients with hemoglobin <80 g/L, 91.7% had an RBC transfusion. Regarding iron therapy, 0.6% of patients received IV iron during the perioperative period. In our cohort, preoperative anemia was associated with increased intensive care unit admissions and hospital length of stay, with patients with hemoglobin <80 g/L at the highest risk. CONCLUSIONS: Preoperative anemia was common in this gynaecologic surgery cohort and was associated with adverse clinical outcomes. Our results highlight the importance of implementing an institutional patient blood management program.