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<p class="p1">Preoperative anemia is progressively being recognized as a risk factor for poor perioperative outcomes including increased length of hospital stay and increased blood transfusions. The growth in prevalence of preoperative anemia in patients undergoing gynecological oncology procedures warrants greater attention to early identification for optimal surgical outcomes. This was a quantitative retrospective observational study consisting of 284 patients undergoing gynecological oncology procedures. The study sought to determine the frequency of anemia, iron deficiency and the effect of anemia on the number of blood transfusions from January 1 to December 31, 2014. Patients with anemia had significantly higher transfusion rates (44% versus 11%, p &lt; 0.0001), considerably higher number of units transfused per patient (mean 1.19 units versus 0.28 units, p &lt; 0.0001) and longer length of stays post-operatively (mean 5.9 days versus 4.6 days, p=0.0008). It was concluded that early identification and treatment of anemia is a key opportunity to optimized surgical outcomes.</p>