Background: Preoperative anemia is a common hematologic problem in major orthopedicrnsurgery. More than one-third of orthopedics patients were anemic preoperatively. Preoperativerninvestigation and treatment of anemia are recommended before orthopedic surgery. Pre-operativernanemia alone is an independent risk factor for perioperative complications, prolonged hospitalrnstays, infection and increased mortality rate. rnObjective: To assess the Prevalence of preoperative anemia and determine associated factorsrnamong adult major elective orthopedics patients at selected governmental hospitals, Addis Ababa, rnEthiopia. From February 1, to April 30, 2021rnMethod A cross-sectional survey was conducted in selected governmental hospitals, AddisrnAbaba, Ethiopia from February 1, to April 30, 2021. A total sample of 242 patients scheduled forrnmajor elective orthopedics was included in the data collection. A systematic random samplingrntechnique was used. Bi-variable and multivariable logistic analyses were done to determinernwhether each of the independent factors is associated or not with the outcome variables. Onlyrnvariable with a p-value < 0.2 during the bi-variable analysis were entered into the multivariablernanalysis. The strength of the association was present by the odds ratio and 95% Confidencerninterval.rnResult: Preoperative anemia was found in 37.6% of the patients. ASA Class 2 were [AOR: 2.5,rn95 % CI: (1.28, 4.89)], malignancy [AOR: 4.37, 95% CI: (1.58,12.1)], history of trauma [AOR:rn3.54, 95 % CI: (1.69, 9.7)], and history of previous surgery [AOR: 4.37, 95% (CI: 1.58,12.1)] werernsignificantly associated with preoperative anemia major elective orthopedics surgery.rnConclusion and recommendation: More than one-third of elective orthopedics patients werernanemic before surgery. ASA class, malignancy, trauma, and surgical history were significantlyrnassociated with preoperative anemia. So, we recommend for major elective orthopedic surgeryrnpatients, early diagnosis and treatment of preoperative anemia were indicated.