Improving the Treatment of Preoperative Anemia in Colorectal and Hepato-Pancreato-Biliary Patients: A Quality Improvement Initiative

Abstract

Introduction: Preoperative anemia for patients undergoing major surgery is associated with increased postoperative morbidity and mortality, including increased requirement for perioperative blood transfusion, length of hospital stay, in-hospital mortality, and ICU admissions. In this quality improvement initiative, the authors describe measures implemented to promote preoperative anemia screening rates and increase uptake in hemoglobin optimizing interventions, with the goal of decreasing perioperative blood transfusion rates.

Methods: Change ideas implemented included establishing a new relationship between the Division of General Surgery and the center's established Patient Blood Management (PBM) program; amending the center's electronic health record to include prebuilt order sets for anemia screening bloodwork, PBM referrals, and oral iron prescriptions; modifying surgical consent packages to include anemia screening questions; and providing education to relevant care team members.

Results: A total of 1,444 patients were included. PBM referrals for anemic patients were increased to 24.6% from 0%. In patients with anemia (n = 754), preoperative treatment was independently associated with a decrease in perioperative blood transfusion (odds ratio 0.42, p = 0.007). Patients connected with the PBM program had decreased lengths of hospital stay (6.6 vs 9.7 days, p = 0.01), admissions to the ICU (1.1% vs 6.7%, p = 0.03), and in-hospital mortality (0% vs 4.3%, p = 0.04) compared to unreferred anemic patients.

Conclusion: The interventions described were successful in decreasing the perioperative blood transfusion rates and improving postoperative outcomes for anemic patients undergoing major surgery. The initiatives were easily incorporated into the existing surgical workflow and can be expanded into other centers and surgical fields.