The incidence of preoperative anemia in gynecological inpatients ranges from 24-45%, with diseases like endometrial polyps, gynecological malignancy, uterine leiomyoma, and adenomyosis being common causes. The diagnostic threshold for anemia is age, gender, and ethnicity-related. A statistical analysis incorporating 18 individual datasets from 8 countries (including China) revealed that, in non-pregnant females aged 18-65 years, the fifth centile was 119.7 g/L, consistent with the World Health Organization (WHO) criteria. Therefore, using 120 g/L as the diagnostic threshold for anemia is reasonable. Even mild preoperative anemia is associated with increased risk of perioperative transfusion and increased morbidity (such as infection, thromboembolic events, and intestinal obstruction) and mortality after surgery. It can also affect patients' recovery, prolong length of stay (LOS), and increase hospitalization costs. In view of these adverse effects, the International Consensus Conference on Patient Blood Management (PBM) in Frankfurt in 2018 strongly recommended timely identification and appropriate management of anemia before major elective surgery. The most common interventions included restrictive red blood cell (RBC) transfusion, using pharmacologic hemostatic agents, and iron therapy. To promote and implement PBM, Chinese clinicians also published the Expert Consensus on Perioperative Blood Management in Gynecological Patients in 2019. However, a national cross-sectional study to assess the prevalence and intervention of preoperative anemia conducted in 2021 showed that the overall prevalence of preoperative anemia in China was 27.57%, but the intervention rate was only 12.57%. This indicated that preoperative anemia is a relatively common issue in China that has not been fully appreciated, potentially leading to unnecessary blood transfusion and increased risk of perioperative complications. Furthermore, previous literature on preoperative anemia in gynecology has mostly focused on elective major surgery or malignant tumor surgery. Comprehensive data on preoperative anemia in gynecological surgeries remains scarce, particularly within the Chinese population. Therefore, our center conducted a single-center, retrospective study to investigate the incidence of preoperative anemia and its impact on perioperative outcomes, including perioperative complications, perioperative RBC transfusion, hospitalization costs, and LOS. The study included surgical patients admitted to the Department of Gynecology at Peking University People's Hospital between April 2023 and January 2024, with data on demographic information, preoperative laboratory tests, diagnoses, surgery records, and hospitalization information. Patients under 18 years old or with missing pre-operative hemoglobin lab recordings within 30 days prior to the operation or other significant information were excluded. The study found that the incidence of preoperative anemia was 30.8%, and patients with preoperative anemia displayed younger age and lower BMI. Multivariate logistic regression analyses showed that preoperative anemia was an independent risk factor for perioperative transfusion and perioperative complications. In addition, preoperative anemia prolonged LOS and increased hospitalization costs. The intervention rate of preoperative anemia in the study was only 11.5%, and common measures included iron supplementation and RBC transfusion. Multivariate logistic regression analyses indicated that preoperative RBC transfusion was a protective factor against perioperative complications. The study emphasized the importance of screening and managing anemia before surgery, proposing an approach to integrate preoperative PBM into routine preoperative protocols. However, the study had limitations, including being a single-center retrospective study and potential bias in case selection. Further research is needed to evaluate long-term complications and prognosis.
