Documented Anemia and Recorded Management Patterns Among Major-Surgery Hospitalizations: A Retrospective Real-World Study

Background/Objectives: Perioperative anemia is common among patients undergoing major surgery and represents an important component of Patient Blood Management (PBM). However, real-world patterns of anemia documentation and management may vary across surgical settings. This study aimed to evaluate the prevalence and distribution of documented anemia and the recorded use of ferric carboxymaltose (FCM) and blood transfusion among major-surgery hospitalizations, comparing two consecutive years and different surgical categories. Methods: This retrospective observational study included 10,571 adult hospitalizations involving major surgical procedures at a Romanian tertiary emergency hospital between 1 January 2017 and 31 December 2018. Routinely collected administrative data were used to identify anemia diagnoses, recorded FCM administration, red blood cell (RBC) transfusion, and selected hospital resource utilization measures. Anemia diagnoses were checked against hemoglobin results documented in the medical records, and the anemia status was recorded as present or absent; individual hemoglobin values were not retained in the dataset. FCM administration and transfusion were recorded across the entire surgical population and could not be consistently linked to individual hospitalizations with documented anemia. Comparisons between years were performed using Pearson’s chi-square test, with effect sizes expressed as odds ratios and 95% confidence intervals. An exploratory analysis assessed length of stay, intensive care unit stay, and surgical duration according to recorded management patterns in selected orthopedic categories. Results: The study included 5370 hospitalizations in 2017 and 5201 in 2018. Documented anemia was recorded in 1514 (28.2%) and 1439 (27.7%) hospitalizations, respectively, showing a relatively stable overall prevalence but substantial variation across surgical categories. Recorded FCM administration decreased in 2018, whereas recorded blood transfusion increased. These frequencies refer to all surgical hospitalizations and do not necessarily represent interventions administered to the same hospitalizations in which anemia was documented. The relationship between documented anemia and recorded management events varied across procedure groups. Exploratory orthopedic analyses also indicated differences in hospital resource utilization between management groups, although interpretation was limited by small subgroup sizes and incomplete variability data. Conclusions: Documented anemia affected approximately one-quarter of major-surgery hospitalizations, while recorded management patterns differed by year and surgical category. These findings support procedure-sensitive clinical audits and more structured PBM pathways but do not establish treatment appropriateness or effectiveness.