Introduction of a Preoperative Protocol for Management of Iron-Deficiency Anemia in Patients undergoing Elective Colorectal Surgery

Preoperative anaemia is a risk factor for poorer postoperative outcomes and patients undergoing colorectal cancer surgery frequently have iron-deficiency anaemia.

The aim of this project was to implement a preoperative anaemia management protocol for elective colorectal surgery patients.

An organisational development project was undertaken according to the Senior and Swailes organisational development model. A protocol for early detection of iron-deficiency anaemia, and treatment with intravenous iron replacement, for colorectal cancer patients was developed and implemented via a multidisciplinary team-based approach. Patient data was collected pre- and post-intervention to assess the impact of the project.

Implementation of the project resulted in increased rates of detection of preoperative iron-deficiency anaemia in the post-intervention cohort, with 71% of patients undergoing ferritin testing, compared to 30% of the pre-intervention cohort. Mean postoperative haemoglobin levels were significantly lower in patients with uncorrected anaemia, whereas those patients who underwent iron replacement therapy preoperatively had similar postoperative results to non-anaemic patients. Overall, postoperative transfusion rates decreased from 10% to 4% following introduction of the protocol.

Successful introduction of a perioperative anaemia management protocol has resulted in reduced preoperative anaemia rates in colorectal cancer patients. Expansion of the inclusion criteria could potentially lead to improved outcomes for additional categories of surgical patients.