Pre-operative haemoglobin levels and iron status in a large multicentre cohort of patients undergoing major elective surgery
Open accessAbstract
Summary: Pre‐operative anaemia in patients undergoing major surgical procedures has been linked to poor outcomes. Therefore, early detection and treatment of pre‐operative anaemia is recommended. However, to effectively implement a pre‐operative anaemia management protocol, an estimation of its prevalence and main causes is needed. We analysed data from 3342 patients (44.5% female) scheduled for either: elective orthopaedic surgery (n = 1286); cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of liver metastases (n = 122). For both sexes, anaemia was defined by a haemoglobin level < 130 g.l −1 ; absolute iron deficiency by ferritin < 30 ng.ml −1 (< 100 ng.ml −1 , if transferrin saturation < 20% or C‐reactive protein > 5 mg.l −1 ); iron sequestration by transferrin saturation < 20% and ferritin > 100 ng.ml −1 ; and low iron stores by transferrin saturation > 20% and ferritin 30–100 ng.ml −1 . The overall prevalence of anaemia was 36%, with differences according to the type of surgery. Laboratory parameters allowing classification of iron status were available for 2884 patients. Among those with anaemia (n = 986), 677 (69%) were women, 608 (62%) presented with absolute iron deficiency, 101 (10%) with iron sequestration; and 150 (5%) with low iron stores. Iron status alterations were similar in women with haemoglobin < 130 g.l −1 or < 120 g.l −1 . For those who were not anaemic (n = 1898), corresponding figures were 656 (35%), 621 (33%), 165 (9%) and 518 (27%), respectively. Anaemia was present in one‐third of patients undergoing major elective procedures. Over two‐thirds of anaemic patients presented with absolute iron deficiency or iron sequestration. Over half of non‐anaemic patients presented with absolute iron deficiency or low iron stores. We consider these data useful for planning pre‐operative management of patients scheduled for major elective surgery.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
NAID is a disease in its own right and warrants attention due to the potential danger it poses for patients (e.g., transfusion requirement and a high rate of morbidity and mortality), especially those who undergo major surgical procedures.
“It is worth paying attention to the evidence that NAID is a disease in its own right and warrants attention due to the potential danger it poses for patients (e.g., transfusion requirement and a high rate of morbidity and mortality), especially those who undergo major surgical procedures [31,32,33,34,35].”
From Defining Global Thresholds for Serum Ferritin: A Challenging Mission in Establishing the Iron Deficiency Diagnosis in This Era of Striving for Health Equity (2025) · cites this paper as [32]
The Introduction says there is emerging evidence that non-anaemic iron deficiency is a disease in its own right, and links low iron stores to increased transfusion requirements and postoperative complications in major surgery. It does not establish a high morbidity or mortality rate specifically for surgical patients with non-anaemic iron deficiency; the Discussion says this study did not match iron-status groups with clinical outcomes, including mortality. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
A systematic analysis of global anemia burden from 1990 to 2010
Kassebaum, N. J., Jasrasaria, R., Naghavi, M., Wulf, S. K., Johns, N. E., Lozano, R., Regan, M. C., Weatherall, D. J., Chou, D. P., Eisele, T. P., et al. (2013) · Blood · doi:10.1182/blood-2013-06-508325 · Cited by 2,115 · see citing works
Management of severe perioperative bleeding
Kozek‐Langenecker, S. A., Afshari, A., Albaladejo, P., Aldecoa, C., ROBERTIS, E. D., Filipescu, D. C., Fries, D. R., Görlinger, K., Haas, T., Imberger, G. L., et al. (2013) · European Journal of Anaesthesiology · doi:10.1097/eja.0b013e32835f4d5b · Cited by 900 · see citing works
International consensus statement on the peri‐operative management of anaemia and iron deficiency
Múñoz, M., Acheson, A. G., Auerbach, M., Besser, M. W., Habler, O. P., Kehlet, H., Liumbruno, G. M., Lasocki, S., Meybohm, P., Baikady, R. R., et al. (2016) · Anaesthesia · doi:10.1111/anae.13773 · Cited by 882 · see citing works
Prevalence and outcomes of anemia in cancer: a systematic review of the literature
Knight, K., Wade, S., & Balducci, L. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2003.12.008 · Cited by 878 · see citing works
Anemia and Patient Blood Management in Hip and Knee Surgery
Spahn, D. R. (2010) · Anesthesiology · doi:10.1097/aln.0b013e3181e08e97 · Cited by 651 · see citing works
Rosencher, N., Kerkkamp, H. E. M., Macheras, G., et al. (2003) · Transfusion · doi:10.1046/j.1537-2995.2003.00348.x · Cited by 618 · see citing works
Serum ferritin concentration and iron stores in normal subjects
Walters, G. O., Miller, F. W., & Worwood, M. (1973) · Journal of Clinical Pathology · doi:10.1136/jcp.26.10.770 · Cited by 618 · see citing works
Conclusions of a WHO Technical Consultation on Folate and Vitamin B 12 Deficiencies
de Benoist, B. (2008) · Food and Nutrition Bulletin · doi:10.1177/15648265080292s129 · Cited by 610 · see citing works
Meta-analysis of the association between preoperative anaemia and mortality after surgery
Fowler, A. J., Ahmad, T. A., Phull, M., Allard, S., Gillies, M. A., & Pearse, R. M. (2015) · British journal of surgery · doi:10.1002/bjs.9861 · Cited by 589 · see citing works
Goodnough, L. T., Maniatis, A. G., Earnshaw, P. H., Benoni, G., Beris, P., Bisbe, E., Fergusson, D. A., Gombotz, H., Habler, O. P., Monk, T. G., et al. (2010) · British Journal of Anaesthesia · doi:10.1093/bja/aeq361 · Cited by 541 · see citing works
Guideline for the laboratory diagnosis of functional iron deficiency
Thomas, W., Hinchliffe, R. F., Briggs, C., Macdougall, I. C., Littlewood, T. J., & Cavill, I. (2013) · British Journal of Haematology · doi:10.1111/bjh.12311 · Cited by 405 · see citing works
Prevalence and outcomes of anemia in surgery: a systematic review of the literature
Shander, A., Knight, K. K., Thurer, R. L., Adamson, J. W., & Spence, R. K. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2003.12.013 · Cited by 383 · see citing works
Froessler, B., Palm, P., Weber, I., Hodyl, N. A., Singh, R., & Murphy, E. M. A. (2016) · Annals of Surgery · doi:10.1097/sla.0000000000001646 · Cited by 353 · see citing works
Patient blood management in Europe
Shander, A., Aken, H. V., Colomina, M., Gombotz, H., Hofmann, A., Krauspe, R., Lasocki, S., Richards, T., Slappendel, R., & Spahn, D. (2012) · British Journal of Anaesthesia · doi:10.1093/bja/aes139 · Cited by 300 · see citing works
Blood use in elective surgery: the Austrian benchmark study
Gombotz, H., Rehak, P., Shander, A., & Hofmann, A. (2007) · Transfusion · doi:10.1111/j.1537-2995.2007.01286.x · Cited by 299 · see citing works
Disorders of iron metabolism. Part II: iron deficiency and iron overload
Múñoz, M., García‐Erce, J. A., & Remacha, A. F. (2010) · Journal of Clinical Pathology · doi:10.1136/jcp.2010.086991 · Cited by 292 · see citing works
Self-citationKotzé, A., Carter, L. A., & Scally, A. (2012) · British Journal of Anaesthesia · doi:10.1093/bja/aes135 · Cited by 252 · see citing works
Patient Blood Management Bundles to Facilitate Implementation
Meybohm, P., Richards, T., Isbister, J. P., et al. (2016) · Transfusion Medicine Reviews · doi:10.1016/j.tmrv.2016.05.012 · Cited by 240 · see citing works
‘Fit to fly’: overcoming barriers to preoperative haemoglobin optimization in surgical patients
Múñoz, M., Gómez‐Ramírez, S., Kozek‐Langeneker, S., Shander, A., Richards, T., Pavı́a, J., Kehlet, H., Acheson, A. G., Evans, C., Raobaikady, R., et al. (2015) · British Journal of Anaesthesia · doi:10.1093/bja/aev165 · Cited by 239 · see citing works
Self-citationPre-operative anaemia: prevalence, consequences and approaches to management.
Múñoz, M., Gómez‐Ramírez, S., Campos, A., Ruiz, J. C., & Liumbruno, G. M. (2015) · PubMed Central · doi:10.2450/2015.0014-15 · Cited by 227 · see citing works
Self-citationPerioperative anaemia management: consensus statement on the role of intravenous iron
Beris, P., Muñoz, M. J., García‐Erce, J. A., et al. (2008) · British Journal of Anaesthesia · doi:10.1093/bja/aen054 · Cited by 216 · see citing works
Self-citationKlein, A. A., Collier, T. J., Brar, M. S., Evans, C., Hallward, G., Fletcher, N., & Richards, T. (2016) · Anaesthesia · doi:10.1111/anae.13423 · Cited by 192 · see citing works
Prevalence and Outcomes of Anemia and Hematinic Deficiencies in Patients With Chronic Heart Failure
Cleland, J. G. F., Zhang, J., Pellicori, P., Dicken, B., Dierckx, R., Shoaib, A., Wong, K., Rigby, A. S., Goode, K. M., & Clark, A. L. (2016) · JAMA Cardiology · doi:10.1001/jamacardio.2016.1161 · Cited by 179 · see citing works
Kotzé, A., Harris, A., Baker, C., Iqbal, T. H., Lavies, N. G., Richards, T., Ryan, K. E., Taylor, C., & Thomas, D. (2015) · British Journal of Haematology · doi:10.1111/bjh.13623 · Cited by 160 · see citing works
Impact of Preoperative Anemia on Outcome in Adult Cardiac Surgery: A Propensity-Matched Analysis
Ranucci, M., Dedda, U. D., Castelvecchio, S., et al. (2012) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2012.04.042 · Cited by 152 · see citing works
on behalf of the Colon Cancer Study Group, Calleja, J. L., Delgado, S., et al. (2015) · International Journal of Colorectal Disease · doi:10.1007/s00384-015-2461-x · Cited by 149 · see citing works
Non‐anaemic iron deficiency – a disease looking for recognition of diagnosis: a systematic review
Pratt, J. J., & Khan, K. S. (2016) · European Journal of Haematology · doi:10.1111/ejh.12645 · Cited by 126 · see citing works
Johansson, P., Rasmussen, A., & Thomsen, L. (2015) · Vox Sanguinis · doi:10.1111/vox.12278 · Cited by 125 · see citing works
Bisbe, E., García‐Erce, J. A., Díez-Lobo, A. I., et al. (2011) · British Journal of Anaesthesia · doi:10.1093/bja/aer242 · Cited by 120 · see citing works
Self-citationCladellas, M., Farré, N., Colet, J. C., Gómez, M., Meroño, O., Bosch, M., Vila, J., Molera, R., Segovia, A., & Bruguera, J. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2012.05.036 · Cited by 111 · see citing works
Theusinger, O. M., Kind, S. L., Seifert, B., et al. (2014) · PubMed · doi:10.2450/2014.0306-13 · Cited by 109 · see citing works
Cuenca, J., García‐Erce, J. A., Martínez, F., CARDONA, R. C., Pérez‐Serrano, L., & Múñoz, M. (2006) · International Journal of Surgery · doi:10.1016/j.ijsu.2006.02.003 · Cited by 103 · see citing works
Self-citationLeal-Noval, S. R., Múñoz, M., Asuero, M., Contreras, E., García‐Erce, J. A., Llau, J. V., Moral, V., Páramo, J. A., & Quintana, M. (2013) · Europe PMC (PubMed Central) · doi:10.2450/2013.0029-13 · Cited by 103 · see citing works
Self-citationPiednoir, P., Allou, N., Driss, F., Longrois, D., Philip, I., Beaumont, C., Montravers, P., & Lasocki, S. (2011) · European Journal of Anaesthesiology · doi:10.1097/eja.0b013e32834ad97b · Cited by 86 · see citing works
González‐Porras, J. R., Colado, E., Sánchez-Conde, P., et al. (2009) · Transfusion Medicine · doi:10.1111/j.1365-3148.2009.00908.x · Cited by 71 · see citing works
García‐Erce, J. A., Cuenca, J., Martínez, F., CARDONA, R. C., Pérez‐Serrano, L., & Múñoz, M. (2006) · Transfusion Medicine · doi:10.1111/j.1365-3148.2006.00682.x · Cited by 62 · see citing works
Self-citationEnjuanes, C., Bruguera, J., Grau, M., Cladellas, M., González, G., Meroño, O., Moliner, P., Verdú-Rotellar, J. M., Farré, N., & Colet, J. C. (2015) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2015.08.018 · Cited by 62 · see citing works
Empty iron stores as a significant risk factor in abdominal surgery
Harju, E. (1988) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607188012003282 · Cited by 42 · see citing works
Rami, M. I., García‐Erce, J. A., Gómez-Barrera, M., Espiérrez, J. C., Sazatornil, R. A., & Hernández, M. J. R. (2008) · Medicina Clínica · doi:10.1157/13128722 · Cited by 39 · see citing works
Self-citationNon-treatment of preoperative anaemia is substandard clinical practice
Spahn, D. R., & Zacharowski, K. D. (2015) · British Journal of Anaesthesia · doi:10.1093/bja/aev099 · Cited by 33 · see citing works
Martín-Cabrera, P., Hung, M., Ortmann, E., et al. (2015) · Journal of Clinical Pathology · doi:10.1136/jclinpath-2015-203024 · Cited by 14 · see citing works
Múñoz, M., Gómez‐Ramírez, S., & Auerbach, M. (2016) · Transfusion · doi:10.1111/trf.13750 · Cited by 11 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 3
- [10]10. Izuel Rami M, Garc ıa Erce JA, G omez-Barrera M, Cuenca- Espi errez J, Abad-Sazatornil R, Rabanaque-Hern andez MJ. Relationship between allogeneic blood transfusion, iron defi- ciency and nosocomial infection in patients with hip fracture. Medicina Cl ınica (Barcelona) 2008; 131: 647-52.
- [25]25. Cuenca J, Garc ıa Erce JA, Mart ınez F, Cardona R, P erez-Serrano L, Muñoz M. Pre-operative haematinics and transfusion proto- col reduce the need for transfusion after total knee replace- ment. International Journal of Surgery 2007; 5: 89-94.
- [36]36. Kozek-Langenecker SA, Afshari A, Albaladejo P, et al. Manage- ment of severe peri-operative bleeding: guidelines from the European Society of Anaesthesiology. European Journal of Anaesthesiology 2013; 30: 270-382.
Cited by
Sorted by citations
Sucrosomial® Iron: A New Generation Iron for Improving Oral Supplementation
Gómez-Ramírez, S., Brilli, E., Tarantino, G., & Muñoz, M. (2018) · Pharmaceuticals · doi:10.3390/ph11040097 · Cited by 132 · see citing works
Self-citationRössler, J., Schoenrath, F., Seifert, B., Kaserer, A., Spahn, G. H., Falk, V., & Spahn, D. R. (2020) · British Journal of Anaesthesia · doi:10.1016/j.bja.2019.09.016 · Cited by 132 · see citing works
Miles, L. F., Kunz, S. A., Na, L. H., Braat, S., Burbury, K., & Story, D. A. (2018) · Anaesthesia · doi:10.1111/anae.14115 · Cited by 51 · see citing works
Miles, L. F., Pac Soo, V., Braat, S., Bade-Boon, J., Heritier, S., Klein, A. A., Myles, P. S., Richards, T., Symons, J., Burbury, K. L., et al. (2022) · The Lancet Haematology · doi:10.1016/s2352-3026(22)00142-9 · Cited by 32 · see citing works
Cancado, R. D., Leite, L. A. C., & Muñoz, M. (2025) · Diagnostics · doi:10.3390/diagnostics15030289 · Cited by 19 · see citing works
Self-citation
- Authors
- Muñoz, M., Laso‐Morales, M. J., Gómez‐Ramírez, S., Cadellas, M., Núñez‐Matas, M. J., & García‐Erce, J. A.
- Affiliations
- Universidad de Málaga (ES)
- Anesthesiology Corporació Sanitarìa Parc Taulí Sabadell Spain
- Hospital Clínico Universitario Virgen de la Victoria (ES)
- Cardiology University Hospital Mar‐Esperança Barcelona Spain
- Hospital Regional Universitario de Málaga (ES)
- Blood and Tissue Bank of Navarra Osansubidea Pamplona Spain
- Corresponding author
- Muñoz, M.
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 2017-04-06
- Volume
- 72
- Issue
- 7
- Pages
- 826-834
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- OpenAlex
- W2605133454
- Cited by
- 229
- References
- 42
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 25 · 2023: 27 · 2022: 34 · 2021: 37 · 2020: 30 · 2019: 23 · 2018: 13 · 2017: 8
- FWCI
- 15.54
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Funders
- Vifor Pharma
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Keywords
- preoperative hemoglobin, iron status, absolute iron deficiency, iron sequestration, ferritin, transferrin saturation, anemia prevalence, elective surgery, orthopedic surgery, cardiac surgery, colorectal cancer surgery, radical prostatectomy, gynecologic surgery, sex differences, anemia management
- MeSH terms
- Iron Deficiencies, Aged, Aged, 80 and over, Anemia, Female, Hemoglobins, Humans, Iron, Male, Middle Aged, Preoperative Care, Cohort Studies, Elective Surgical Procedures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
