Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking

Overview

Preoperative anaemia, poorly controlled blood glucose and smoking are common and modifiable risk factors. Each is linked to more postoperative complications, transfusions, infections and longer hospital stays. This clinical practice guideline brings the three factors together in one evidence-based framework. It offers recommendations and a practical algorithm for optimising patients before elective surgery, and is intended for anaesthetists, surgeons, primary care physicians and perioperative teams.

Anaemia

The guideline recommends screening for anaemia well before elective surgery so there is time to investigate and treat it. The underlying cause should be identified, and correcting iron deficiency is a priority. Correcting anaemia before surgery is presented as a key part of patient blood management, reducing the need for transfusion and its associated risks.

Hyperglycaemia

Patients with known diabetes and those at risk of undiagnosed hyperglycaemia should have their glycaemic control assessed before surgery. The guideline advises optimising glucose control in advance. In poorly controlled cases, it recommends weighing the risks of proceeding against the benefits of postponing elective surgery. Coordination between the surgical team and the professionals managing the patient's diabetes is emphasised.

Smoking

Every surgical patient should be asked about smoking and offered cessation support, ideally as early as possible before the operation. The guideline presents surgery as a teachable moment: structured counselling and support can reduce complications and may lead to lasting abstinence.

Clinical implications

Its main message is that optimisation should start at the moment surgery is planned, not on the day of admission. The integrated algorithm helps institutions organise preoperative pathways that address all three risk factors systematically.