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Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery., Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1-2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay., Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54-13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85-3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone., Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered., Competing Interests: Henning Uden, Franziska Büttner, Michael Krämer, Gerald Vorderwülbecke, Sebastian Hardt, and Jochen Kruppa: None. Christian von Heymann declares to have no financial conflict of interest related to the topic of this manuscript. He also declares that he was mandated from the German Society of Anesthesiology and lntensive Care Medicine (DGAI) to write the German Guideline on Preoperative Anemia (published in April 2018) and that he was part of the writing group of the Patient Blood Management Guideline in cardiac surgery on behalf of the European Society of Cardiothoracic Anaesthesiologists (EACTA) in conjunction with the European Society of Cardiothoracic Surgery (EACTS) (published in September 2017). Outside this work, Christian von Heymann discloses to have received research funding, speaker’s and consultancy honoraria, and travel reimbursements from CSL Behring, Daiichi Sankyo, HICC GbR, Mitsubishi Pharma GmbH, NovoNordisk Pharma GmbH, Shionogi Pharma, and Sobi Pharma. Lutz Kaufner declares to have no financial conflict of interest related to the topic of this manuscript. He also declares that he was mandated from the German Society of Anesthesiology and lntensive Care Medicine (DGAI) to write the German Guideline on Preoperative Anemia (published in April 2018). He discloses to received speaker’s and consultancy honoraria and travel reimbursements from HICC GbR., CSL Behring, and Novo Nordisk outside the submitted work. Claudia Spies reports grants from Deutsche Forschungs-gemeinschaft/German Research Society, grants from Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR)/German Aerospace Center, grants from Einstein Stiftung Berlin/Einstein Foundation Berlin, grants from Gemeinsamer Bundesausschuss/Federal Joint Committee (G-BA), grants from Inneruniversitäre Forschungsförderung/Inner University Grants, grants from Projektträger im DLR/Project Management Agency, grants from Stifterverband/Non-Profit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from Baxter Deutschland GmbH, grants from Cytosorbents Europe GmbH, grants from Edwards Lifesciences‚ Germany GmbH, grants from Fresenius Medical Care, grants from Grünenthal GmbH, grants from Masimo Europe Ltd‚ grants from Pfizer Pharma PFE GmbH, personal fees from Georg Thieme Verlag, grants from Dr. F. Köhler Chemie GmbH‚ grants from Sintetica GmbH, grants from Stifterverband für die deutsche Wissenschaft e.V./Philips, grants from Stiftung Charite, grants from AGUETTANT Deutschland GmbH, grants from AbbVie Deutschland GmbH & Co. KG, grants from Amomed Pharma GmbH, grants from InTouch Health, grants from Copra System GmbH, grants from Correvio GmbH, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften e.V., grants from Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin (DGAI), grants from Stifterverband für die deutsche Wissenschaft e.V./Metronic, grants from Philips ElectronicsNederland BV, grants from BMG, grants from BMBF, grants from Deutsche Forschungsgemeinschaft/German Research Society, and grants from Drägerwerk AG & Co. KGaA, outside the submitted work. In addition, Dr. Spies has a patent 10 2014 215 211.9 licensed, a patent 10 2018 114 364.8 licensed, a patent 10 2018 110 275.5 licensed, a patent 50 2015 010 534.8 licensed, a patent 50 2015 010 347.7 licensed, and a patent 10 2014 215 212.7 licensed. Felix Balzer reports grants from German Federal Ministry of Education and Research, grants from German Federal Ministry of Health, grants from Berlin Institute of Health, personal fees from Elsevier Publishing, grants from Hans Böckler Foundation, other from Robert Koch Institute, grants from Einstein Foundation, and grants from Berlin University Alliance, outside the submitted work., (© 2023 The Author(s). Published by S. Karger AG, Basel.)