Cancelled operations could be prevented by an earlier anaemia test and time to prepare

One third of people who are having major surgery have anaemia, meaning they are more vulnerable to blood loss, poor wound healing, longer rehabilitation and increased risk of death after their operation.
In fact, people with anaemia – where the blood has a low oxygen-carrying capacity – have two to three times more complications than non-anaemic patients.
Yet despite this, patients are not tested for anaemia with enough time for them to address it prior to their operation, presenting surgical teams with the binary decision to cancel the operation at short notice or proceed knowing there will be risks.
The figures, along with remedies for patient teams to follow, are published today by the Centre for Perioperative Care (CPOC) alongside calls for anaemia to be ‘viewed as a serious and treatable medical condition rather than simply an abnormal laboratory value’.
CPOC Deputy Director and consultant surgeon Professor Scarlett McNally, who co-authored the report, said it was important for everyone involved in a patient’s care – including the patient themselves – to use waiting times wisely and prepare for surgery. This is a perioperative approach.
Professor McNally said: “As a surgeon, I see the problems for patients having operations with anaemia and even making it worse. The guideline shows that improvements work with simple interventions such as changes to diets, recommending iron tablets are taken on alternate days or using Tranexamic acid to reduce bleeding during major surgery.
“This isn’t just about the operation, but about the whole team, including the patient. In the past, guidelines felt hidden in different specialties. This new guideline has freed up the knowledge and evidence for everyone – for all staff who care for patients and for people having surgery and their families. Following Covid, it is even more important – if patients are not anaemic, they leave hospital sooner and have fewer complications, so this frees up beds for other patients.”
The Guideline for the Management of Anaemia in the Perioperative Pathway highlights several key figures:
More than 1/3 of patients having major surgery are anaemic before their operation, varying between 5% and 75% across specialities
People with anaemia have two or three times the rate of complications
Anaemia as an independent risk factor is responsible for 20% more complications
People with anaemia have poorer wound healing, slower mobilisation and an increased risk of death
It can take three to six months to replenish iron stores
Oral iron takes four weeks to have an impact on haemoglobin levels
Taking iron tablets too frequently switches off iron absorption
In the UK, at least 1 in 4 pregnant people experience anaemia in pregnancy
In the UK, 31% of babies are delivered by Caesarean section, of which 56% are as an emergency. 12% of births have an instrumental delivery. A small percentage of pregnant people require non-obstetric surgery, 22% sustain a post-partum haemorrhage, of which 13% (3% of deliveries) involves 1,500ml blood loss and 30% are anaemic after birth.
A10g/L increase in haemoglobin has been estimated to decrease the risk of maternal mortality by 29%, and perinatal mortality by 28%.
Anaemia in the first or second trimester of pregnancy significantly increases the risk of low birth weight and preterm birth
In the UK, 45% of major operations are in people over the age of 65 who have multiple medical problems
CPOC advocates for patient-preparation in seven key areas: nutrition, exercise, smoking cessation, medication review, psychological input and empowerment, alcohol moderation and preparation for post-operative practicalities. These reduce complications by a third to a half, reduce length of stay and give patients more options to have their procedures as a day case rather than as part of an overnight stay in hospital.
CPOC has shown these impacts on patient flow could be useful in a time of lengthy waiting lists and a shortage of NHS beds. Specifically in anaemia, people who are fitter can withstand the impact of anaemia better.