Preoperative anaemia is common in surgery, with a prevalence between 10 and 50 %, and is an independent risk factor for morbidity and mortality. Due to the potential risk of additional blood loss, anaemia represents a serious disease condition within the surgical field. Especially patients undergoing major elective surgery are at risk of substantial blood loss. Anaemia is mostly the result of an inadequate erythropoiesis due to iron deficiency, lack of vitamin B12 or folate, and bone marrow diseases. Among the elderly, renal disease and chronic inflammation account for approximately one-third of all anaemia incidences. The aim of this study is to provide detailed data about the prevalence of preoperative deficiencies in iron, vitamin B12 and/or folate and the presence of underlying renal or chronic diseases in patients undergoing major surgery. Results will facilitate design of supplementation strategies to improve haemoglobin level before surgery.



The main objective of ALICE is to estimate the prevalence of preoperative anaemia and subtypes (anaemia caused by deficiency in iron, vitamin B12 and/or folate, and renal or chronic disease) in patients undergoing major surgery. A secondary objective is the assessment of the association of preoperative anaemia and subtypes with in-hospital morbidity and mortality accounting for other predictive factors (e.g. age, surgical discipline).


Study design

ALICE is a worldwide multicentre, prospective observational study.
Recruitment period: 1 week

Inclusion criteria

• Age ≥ 18 years
• Written informed consent prior to study participating according to the national law requirements
• Patients undergoing major surgery
• Expected hospital stay with a minimum of 24 hours


Exclusion criteria

• Preoperative autologous blood donation
• Patients with expected re-surgery within the planned 7-day recruitment period


Recording of endpoints

All data will be collected and there will be no study-related interventions.