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José Antonio García Erce: Preoperative Anemia Emerges as a Modifiable Surgical Risk in New POWER Study

José Antonio García Erce/LinkedIn

Oct 23, 2026, 15:29

José Antonio García Erce: Preoperative Anemia Emerges as a Modifiable Surgical Risk in New POWER Study

José Antonio García Erce, Vocal-Elect of the Board of the Spanish Society of Hematology and Hemotherapy, shared Sociedad Iberoamericana de Patient Blood Management’s post on LinkedIn:

“A new national multicenter study from the POWER project led by Dr Javier Ripolles and Ane Abad Motos revealing the risk and importance of anaemia.”

Sociedad Iberoamericana de Patient Blood Management shared a post on LinkedIn:

“Does preoperative anemia really cause more complications, or is it just a marker that the patient was already sicker?

A new study responds with cutting-edge methodology: causal inference.

The team of Ripolles-Melchor et al. analyzed two large European prospective cohorts of elective colorectal surgery—EuroPOWER (2,826 patients, 185 hospitals, 21 countries) and POWER (1,185 patients, Spain)—using Targeted Maximum Likelihood Estimation (TMLE), a technique that estimates the actual causal effect, not just the statistical association.

Results:

In EuroPOWER, preoperative anemia increased the risk of complications at 30 days from 23.6 percent to 28.6 percent (estimated causal effect: plus 5.05 percentage points; 95 percent CI 1.20-8.91; p=0.01)
Combined meta-analysis of both cohorts: plus 4.65 p.p. (95 percent CI 1.69-7.60; p=0.002)
Number Needed to Treat (NNT): approximately 20-25 patients
Specific association with more acute kidney injury, surgical site infection, and pulmonary complications
The ‘E-value’ (1.92) suggests that the finding is robust against unmeasured confounders

Most importantly, the risk tipping point was between 11-12 g/dL of hemoglobin — very close to the WHO thresholds we already use to define anemia.

The authors themselves are careful: this strengthens the case for screening and systematic optimization of preoperative anemia (central pillar of GSP), but does not prove that a specific intervention will exactly replicate this benefit.

We are happy to note that among the authors is our colleague José Antonio García-Erce, from the Spain Chapter of the SIAPBM (Blood and Tissue Bank of Navarra) — one more contribution from our community to the evidence that supports the Management of Patient Blood.”

José Antonio García Erce: Preoperative Anemia Emerges as a Modifiable Surgical Risk in New POWER Study