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Background and Importance Hospital pharmacists enhance perioperative safety by preventing medication errors and optimising high-risk drug management. Despite guidelines, deviations persist due to polypharmacy and clinical complexity, highlighting the need for pharmacist involvement in surgical teams.Aim and Objectives The primary objective was to evaluate the impact of hospital pharmacists’ interventions in reducing surgery cancellations related to medication errors. Secondary objectives were to describe and quantify interventions across perioperative phases and to identify patient or surgical factors associated with increased risk of errors.Material and Methods We conducted a prospective observational study (2021–2024) in a tertiary hospital in Spain. Adult surgical patients on chronic anticoagulant or antiplatelet therapy were included. Pharmacists performed structured consultations at three stages: preoperative review (including medication reconciliation and patient education), inpatient reconciliation, and post-discharge follow-up. Interventions were recorded in electronic health records. Collected variables included demographics, comorbidities, pharmacological profiles, and surgical data. Statistical analysis included descriptive summaries and multivariate logistic regression to identify predictors of medication errors and pharmacist interventions, with significance set at p < 0.05.Results A total of 1,141 patients were included, mean age 73.1 years, with predominance of males (67.1%). Patients received a mean of 9.1 chronic medications, with most being polymedicated. Anticoagulants were prescribed in 79.1% and antiplatelets in 16.1%.In the preoperative phase, 26.2% of patients did not adequately understand treatment management, leading to 346 pharmacist interventions, 25.7% involving high-risk drugs. Surgery was postponed in 8.4% of cases (1.3% pharmacological). Risk factors for poor comprehension included advanced age, diabetes, polypharmacy, rivaroxaban/edoxaban, and longer intervals between anesthesiology consultation and surgery.During admission, reconciliation was accurate in 69.8% of cases. However, 30.2% of patients had at least one error, with 223 errors prevented, mainly related to anticoagulants. Polypharmacy was the main independent predictor.At discharge, 39.1% failed to recall recommendations, resulting in 255 errors prevented. Risk factors included polypharmacy and higher pain scores, while female sex was protective. Interventions focused on adherence (66.6%), coordination with professionals (21.2%), and emergency referral (6.7%). Patient satisfaction was very high (9.8/10).Conclusion and Relevance Pharmacist-led perioperative interventions reduced medication errors and surgery cancellations. Polypharmacy, age, and comorbidities were key risk factors, highlighting the pharmacist’s role in optimising patient safety.Conflict of Interest No conflict of interest