Proactive care before surgery, often referred to as preoperative optimization, includes managing anemia, hyperglycemia, and smoking—could transform patient outcomes and healthcare efficiency.
A Shift in Surgical Preparation
In a landmark clinical guideline published by the Canadian Medical Association Journal (CMAJ) October 2025 issue, researchers emphasized the critical role of preoperative optimization in improving surgical outcomes. Focusing on modifiable risks—anemia, hyperglycemia, and smoking—the new recommendations provide a roadmap for significantly reducing surgical complications. With millions undergoing elective surgeries annually, this guideline marks a pivotal step forward.
Why Preoperative Risks Matter
An increasing number of studies, including recent data from The World Health Organization on global anemia prevalence, reveal how undiagnosed or unmanaged conditions can lead to adverse surgical events. Hyperglycemia impairs wound healing, while smoking increases pulmonary risks and delays recovery, underscoring the need for preoperative optimization efforts. These issues have long been noted in practice but were seldom addressed systematically pre-surgery.
Healthcare providers across Canada and globally are now urged to integrate standardized screening and intervention protocols at least 6–8 weeks before elective procedures.
For a detailed medical perspective on surgical health, see our internal article:
Strategies for Managing Preoperative Risks
Tackling Anemia
- Screening: Complete blood count (CBC) and ferritin tests.
- Treatment: Oral iron for iron-deficiency anemia; IV iron or erythropoietin for patients unresponsive to oral supplements. Effective preoperative optimization strategies in anemia management are crucial.
Learn more on our health platform: COVID-19 Vaccine Manitoba: Who Should Get Boosted Before Summer 2025?
Controlling Hyperglycemia
- Screening: Use HbA1c to determine long-term glucose control.
- Intervention: Maintain preoperative glucose levels between 5–10 mmol/L; refer to endocrinology if HbA1c ≥ 8.5%. This forms a vital component of preoperative optimization in controlling hyperglycemia.
External link: CDC Diabetes Resources
Supporting Smoking Cessation
- Methods: Combine behavioral counseling with pharmacotherapy (e.g., nicotine replacement, varenicline).
- Timing: Quit at least 8 weeks before surgery as part of thorough preoperative optimization.
Read more: Revolutionizing Nutrition: The Seed-Based Vitamin Fix
Broader Impact: Policy, Hospitals, and Patients
Integrating preoperative optimization could:
- Reduce surgical site infections and readmission rates
- Shorten hospital stays and improve bed turnover
- Lower overall healthcare costs by preventing complications
- Boost patient satisfaction and mental readiness through effective preoperative optimization practices
Clinical teams, especially in primary care, must adopt a collaborative care model, ensuring timely referrals and early detection. Technology can play a major role—EHR systems can automate reminders and embed checklists for anemia, glucose, and smoking assessment.
What’s Next? Outlook and Recommendations
As the healthcare system evolves, preoperative optimization may soon become a requirement rather than an option.
- Short-Term: Pilot programs in academic hospitals
- Long-Term: Integration in national surgical protocols
- Research Needs: Better data on ethnic and gender-based differences in response to interventions
Public response has been positive, particularly among advocacy groups and surgical specialists calling for safer, smarter surgery.
Proactive is Powerful
Preoperative optimization isn’t just a checklist—it’s a mindset shift in surgical care. By addressing anemia, hyperglycemia, and smoking well before patients enter the OR, we stand to improve lives, cut costs, and reduce suffering. Read more
For patients, this could mean fewer complications, faster recovery, and better outcomes. For providers and hospitals, it’s a path to more resilient and efficient care delivery.
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