To determine the association between preoperative anemia and perioperative complications in patients undergoing anterior colporrhaphy, utilizing the standardized Clavien-Dindo classification system for comprehensive complication assessment.

This retrospective cohort study analyzed 231 women who underwent anterior colporrhaphy at a tertiary medical center in southern Israel between 2014 and 2023. Patients were stratified by preoperative hemoglobin levels, with anemia defined as hemoglobin <11 g/dL. Demographic, clinical, obstetrical, and operative characteristics were compared between anemic and non-anemic groups. Perioperative complications were systematically documented during a 12-month follow-up period using Clavien-Dindo classification system. Univariate analysis identified variables associated with complications (P < 0.2), which were subsequently included in multivariate logistic regression modeling to control potential confounders.

During the 12-month follow-up period, 48% of participants experienced at least one perioperative complication, with minor complications (Clavien-Dindo grades 1-2) predominating. A significant association was observed between preoperative anemia and complication rates; 90% of women with hemoglobin levels <11 mg/dL experienced at least one complication compared to 46% of non-anemic women (p=0.006). Preoperative anemia showed a significant association with diabetes (p<0.001), while no significant associations were found with advanced age, grand multiparity (>5 births), obesity (BMI >30), or substantial intraoperative blood loss (>2 g/dL). After adjusting for confounders including age and diabetes in multivariate analysis, preoperative anemia remained an independent risk factor for perioperative complications (adjusted hazard ratio=10.33, 95% CI 1.251-85.32, p=0.03).

This study found that preoperative anemia is strongly associated with an increased risk of perioperative complications in women undergoing anterior colporrhaphy. Nearly 90% of anemic patients (hemoglobin <11 g/dL) experienced complications compared to 46% of non-anemic patients, with most being minor (Clavien-Dindo grade 1–2). After adjusting for confounders such as age and diabetes, anemia remained an independent risk factor with a ten-fold increased risk (adjusted hazard ratio = 10.33, p=0.03). These findings highlight the importance of identifying and treating anemia preoperatively to reduce complication rates in pelvic reconstructive surgery.

Preoperative anemia independently confers a ten-fold increased risk for perioperative complications following anterior colporrhaphy. These findings highlight the importance of preoperative hemoglobin optimization as a potentially modifiable risk factor that could significantly reduce complication rates in women undergoing pelvic reconstructive surgery.