Preoperative anaemia is common in patients undergoing major gynaecological surgery and is associated with a fivefold increased risk of transfusion.

Another patient population was identified that may, potentially, benefit from a patient blood management program. This retrospective study analyzed data from 824 women who underwent laparoscopic and open major gynecological surgery in an Australian tertiary hospital. Preoperative anemia was present in 18% of patients. As hypothesized, blood transfusion was more frequent in anemic as opposed to nonanemic subjects (55 vs. 16%), in ASA class III-V ( 39 vs. 20%), and in open abdominal procedures (92 vs. 38%).

Although the study was underpowered to demonstrate the effect of preoperative anemia on length of hospital stay and morbidity, it is worth reading for two reasons. First, surgical technique is key in blood-sparing methods. Whereas open gynecological surgery was associated with an overall transfusion rate of 13 to 15%, endoscopic or vaginal surgery incurred a risk of transfusion of 1%. Second, retrospective analyses obey to the same rules as prospective studies. Although the authors included a time frame that was too short, along with a selection of procedures with too low transfusion rates to produce adequately powered results, the database-derived analysis was published with all its weaknesses. This demonstrates good clinical practice.

– Thomas Frietsch