Preparing for Elective Surgery: Why Blood Health Matters
A leading pediatric anesthesiologist on why pre-operative anemia is one of the most consistently overlooked questions in surgical care, and what informed conversation changes. Featuring Dr. Susan Goobie.
Most people focus on the operation itself. The day, the procedure, the recovery. But preparing for elective surgery begins weeks earlier, and one of the most important conversations rarely happens at all. That conversation is about your blood.
Iron deficiency, anemia, and the broader question of how well-prepared your body is for surgery often go unspoken. So patients arrive in the operating room with low iron stores, low hemoglobin, or both, and the team works with what they have. There is a different way. It starts with a question most surgical patients are never asked.
Dr. Susan Goobie has spent 25 years asking it. As a pediatric anesthesiologist at Boston Children’s Hospital and Chair of the American Society of Anesthesiologists Patient Blood Management Committee, she sees pre-operative anemia almost daily. So in this conversation, she explains why preparation matters, what informed consent really looks like, and how the conversation between patient and clinician changes outcomes.
Why pre-operative anemia is the low-hanging fruit
Surgery puts demands on the body that go beyond the wound itself. Healing requires oxygen. Hemoglobin carries oxygen through the body. Hemoglobin needs iron. So if anything weakens any link in that chain before surgery begins, recovery takes longer and complications become more likely. Preparing for elective surgery starts with making sure that chain is strong.
This is not new information. Susan describes seeing it every day in clinic.
“Every day I see patients who are anemic and every day the lab work comes the night before their surgery. I was always sort of a little perplexed as why this was always ignored. A hemoglobin of eight or 10 or nine. Why was this just ignored and accepted?”
Dr. Susan Goobie
Her observation matters because it captures a systemic gap, not an individual failing. The lab work is there. The patient is there. The signal is there. And yet the chance to act on it gets missed. Susan calls this gap one of the clearest opportunities in surgical care.
“That’s a low-hanging fruit that is something that we can work together with our surgeons and nurses and pediatricians to help diagnose and manage better. Because we shouldn’t really accept this as normal.”
Dr. Susan Goobie
In Other Words
Pre-operative anemia: low red blood cell count or low hemoglobin identified before surgery. Often present for weeks or months before being noticed, and a common but addressable cause of slower recovery.
Patient Blood Management (PBM): a multidisciplinary approach that focuses on protecting and optimizing a patient’s own blood across the surgical journey, including before, during, and after the operation.
Elective surgery: a planned, non-emergency operation. The planning window is what makes pre-operative optimisation possible.
Patient Blood Management is a new standard of care
Patient Blood Management has been part of surgical practice for decades, but the field has changed significantly. What used to be a specialist interest now sits at the center of how leading hospitals approach surgery, including elective surgery preparation across all ages.
“Patient blood management is a new standard of care. And honestly, I think that we need to do more education. It’s not that anesthesiologists don’t care. They very much care. But they just don’t know.”
Dr. Susan Goobie
That distinction matters. Susan is not saying clinicians are failing patients. She is saying the education has not caught up with the evidence. Patient Blood Management asks a different set of questions before surgery, including how to optimize a patient’s blood health in the weeks before they arrive in the operating room. So change in any clinical culture takes time
“It’s one of the hardest things, this changing culture. We’ve always done it that way. The patient’s anemic, well, we can just give them blood. Just sort of changing that culture is extremely hard.”
Dr. Susan Goobie
What replaces the old approach is something more thoughtful: looking at the patient before surgery, understanding their full picture, and giving them the chance to be in the best condition possible before the operation begins.
Why preparation runs in the family
Iron deficiency is not only a surgical concern. It quietly affects millions of people across every stage of life. Susan saw it close to home.
Her father, in his late eighties, and her father-in-law, in his late nineties, were both severely iron deficient. So she understood from a personal vantage point what so many patients experience: the assumption that fatigue is just age, that tiredness is just life, that nothing can be done. Her father-in-law had been prescribed oral iron and was not responding. Iron deficiency in older adults is often more complicated than a single prescription. So she gave both men a copy of Blood Works, the book on blood health written for general readers.
“My dad read it. He said, really helped me understand and I really never understood that from my doctor before. And for the first time he understood in his own mind what it meant and the implications of it.”
Dr. Susan Goobie
That moment, where someone finally understands what iron deficiency means and why it matters, is what good blood health education is for. So it is also what preparing for elective surgery should look like at its best. When patients understand the why, they engage with the how.
What informed consent really looks like
The phrase “informed consent” appears on every surgical document. But what does it actually mean when someone is preparing for elective surgery? Susan has a clear answer.
“The great thing about patient blood management is, it’s very, very much driven by patient centered care and informed consent. The patient is involved in their health care decisions, especially around their blood health.”
Dr. Susan Goobie
That kind of informed consent is not a signature on a form. It is the patient knowing what is happening with their own body, understanding the choices in front of them, and being part of the conversation about what comes next. For someone preparing for elective surgery, that conversation matters most in the weeks before the operation, not the moments before.
When clinicians make space for that conversation, the surgical team gets to know the patient as a person. Susan describes this as one of the underrated parts of anesthesia practice.
“For the patient interaction that anesthesiologists have, it’s quality, not quantity. In the very short time that you get to meet your anesthesiologist, it’s extremely important that you both take the time to discuss the things that are important.”
Dr. Susan Goobie
Did you know?
- Pre-operative anemia is a known predictor of slower recovery, longer hospital stay, and increased risk of complications after surgery.
- Iron deficiency without anemia can be present in surgical patients long before hemoglobin levels drop.
- Patient Blood Management is recognized by the World Health Organization as a standard of care for surgical patients.
- Preparing for elective surgery in the weeks beforehand can include addressing iron status, hydration, and overall wellbeing.
- Informed consent is most meaningful when it begins as a conversation, not a form.
Treating the patient, not the number
One of the clearest insights from Susan’s 25 years in practice is this: numbers on a chart matter less than the person attached to them. When preparing for elective surgery, Patient Blood Management depends on looking at each patient as a whole, not a hemoglobin reading.
“It’s really telling the physicians, treat the patient, not the number.”
Dr. Susan Goobie
That principle changes how surgical decisions are made. So a patient with a hemoglobin of nine is not just a hemoglobin of nine. They are someone with a history, a body, a life, and a surgery ahead of them. The right next step depends on who they are, not just what the lab reports.
Trusted Voices
What authoritative health sources say about iron deficiency awareness and blood health
Patient blood management is an evidence-based, multidisciplinary approach to optimising the care of patients who might need a blood transfusion.”
Preoperative anemia is associated with increased postoperative morbidity, mortality, and hospital length of stay across surgical specialties.”
Identification and management of preoperative anemia is a core pillar of Patient Blood Management, and should be addressed in the weeks before surgery wherever possible.”
Anaemia is a key independent risk factor for poor surgical outcomes, and one of the most modifiable factors in the preoperative period.”
Questions to Ask
- When did I last have my iron stores checked, including ferritin and not just hemoglobin?
- Could pre-operative anemia be affecting my recovery prospects?
- Is there time before my surgery to address my blood health?
- Who in the surgical team can talk to me about Patient Blood Management?
- What does informed consent mean for my specific situation, beyond signing a form?
- How can my family and I be part of the conversation about my care?
The conversation that changes outcomes
Preparing for elective surgery is more than a date on the calendar. It is a window of weeks where the right conversation, the right tests, and the right preparation can change how someone recovers. So when patients know to ask, and when clinicians have the time to answer, outcomes improve.
Susan’s work, across two and a half decades of pediatric anesthesia and Patient Blood Management leadership, comes back to a simple idea. The patient is not just a hemoglobin reading. They are a person. And the conversation matters.
Preparing for elective surgery is more than a date on the calendar. It is a window of weeks where the right conversation, the right tests, and the right preparation can change how someone recovers. So when patients know to ask, and when clinicians have the time to answer, outcomes improve.
Susan’s work, across two and a half decades of pediatric anesthesia and Patient Blood Management leadership, comes back to a simple idea. The patient is not just a hemoglobin reading. They are a person. And the conversation matters.
If you have surgery coming up, when will you start the conversation about your blood health?
Disclaimer:
This information is educational, not medical advice. Always talk to your doctor before making changes to your health care.
