This is a large multicenter study that analyses The American College of Surgeon’s National Surgical Quality Improvement Program database of 227,425 patients undergoing major non-cardiac surgery. The authors observed that one third of patients had preoperative anemia, but the main finding of their study was that preoperative anemia, even to a mild degree, was significantly and independently associated with increased postoperative 30-day morbidity and mortality. They conclude that, at least in elective surgical cases, the treatment of preoperative anemia before a surgical intervention should be strongly considered. One important limitation of the study is that the database does not document the use of 4 units or fewer red cell transfusions in the perioperative period. Thus, some patients regarded as not having received any transfusion might well have been transfused nonetheless.

– Elvira Bisbe