Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Apr 5;29(1):92.
doi: 10.1007/s10151-025-03131-5.

Early detection and correction of preoperative anemia in patients undergoing colorectal surgery-a prospective study

A de Wit  1   2 , B T Bootsma  1   2 , D E Huisman  1   2 , G Kazemier  1   2 , F Daams  3   4 ; Taskforce Anastomotic Leakage
Collaborators, Affiliations
Multicenter Study

Early detection and correction of preoperative anemia in patients undergoing colorectal surgery-a prospective study

A de Wit et al. Tech Coloproctol. .

Abstract

Introduction: Preoperative anemia is an important target in preventing colorectal anastomotic leakage (CAL). However, it is not consistently detected and corrected in patients undergoing colorectal surgery. This study aimed to evaluate the impact of early detection and correction of preoperative anemia on perioperative outcomes and CAL.

Methods: This was a prospective subanalysis of an international open-labeled trial, which implemented an enhanced care bundle to prevent CAL after elective colorectal surgeries. It introduced interventions for early detection and correction of preoperative anemia. Primary outcome was the incidence of preoperative anemia and the effect of early correction. Secondary outcomes included the impact on CAL, postoperative course, and mortality.

Results: The study included 899 patients across eight European hospitals (September 2021-December 2023). Preoperative anemia was identified in 35.0% (n = 315) of participants, with 77.4% (n = 192) receiving iron therapy. Hemoglobin levels decreased in 4.2% (n = 13), remained stable in 45.8% (n = 143), and increased in 50.0% (n = 156) (p < 0.001). Perioperative hyperglycemia was more common among patients with anemia (7.8% versus 16.4%, p < 0.001). CAL occurred in 6.1% (n = 53) of patients. Anemia correction and changes in hemoglobin levels after iron treatment were not significantly associated with CAL, other complications, or mortality.

Conclusions: Early detection and correction of preoperative anemia is achievable. However, routine preoperative administration of iron alone, without concurrently optimizing other CAL risk factors, does not result in CAL prevention. Preoperative anemia indicates overall poor physiological fitness rather than being an isolated risk factor.

Trial number: NCT05250882 (20-01-2022).

Keywords: Anastomotic leakage; Anemia; Colorectal surgery; Iron transfusion.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interests: F.D. received an educational grant from Medtronic. Medtronic had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. All other authors declare no conflict of interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethical Committee of the Vrije Universiteit and the eight participating hospitals (16-03-2021; 2020.0634), and declared exempt from the Medical Research Involving Human Subjects Act (WMO). Informed Consent: All patients provided written informed consent for participation and publication prior to participation in this study.

References

    1. Zarnescu EC, Zarnescu NO, Costea R (2021) Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics. 10.3390/diagnostics11122382 - PMC - PubMed
    1. Sparreboom CL, Van Groningen JT, Lingsma HF, Wouters MW, Menon AG, Kleinrensink G, Jeekel J, Lange JF (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61(11):1258–1266. 10.1097/dcr.0000000000001202 - PubMed
    1. Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC, Ris F (2019) Reducing anastomotic leak in colorectal surgery: the old dogmas and the new challenges. World J Gastroenterol 25(34):5017–5025. 10.3748/wjg.v25.i34.5017 - PMC - PubMed
    1. Van Rooijen S, Huisman D, Stuijvenberg M, Stens J, Roumen R, Daams F, Slooter G (2016) Intraoperative modifiable risk factors of colorectal anastomotic leakage: why surgeons and anesthesiologists should act together. Int J Surg 36:183–200. 10.1016/j.ijsu.2016.09.098 - PubMed
    1. Huisman DE, Reudink M, Van Rooijen SJ, Bootsma BT, Van de Brug T, Stens J, Bleeker W, Stassen LPS, Jongen A, Feo CV, Targa S, Komen N, Kroon HM, Sammour T, Lagae EAGL, Talsma AK, Wegdam JA, De VriesReilingh TS, Van Wely B, Daams F (2020) LekCheck: a prospective study to identify perioperative modifiable risk factors for anastomotic leakage in colorectal surgery. Ann Surg. 10.1097/sla.0000000000003853 - PMC - PubMed

Publication types

MeSH terms

Associated data