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. 2025 Aug 5:201:7-16.
doi: 10.1016/j.ygyno.2025.07.027. Online ahead of print.

Optimizing the screening and management of preoperative anemia prior to gynecologic oncology surgery (OPRA1): A quality improvement initiative

Elisabeth Spénard  1 , Yulia Lin  2 , Al Covens  3 , Lilian T Gien  3 , Jeannie Callum  2 , Ruby Tano  2 , Saudia Jadunandan  2 , Patricia Trbovich  4 , Danielle Vicus  5
Affiliations

Optimizing the screening and management of preoperative anemia prior to gynecologic oncology surgery (OPRA1): A quality improvement initiative

Elisabeth Spénard et al. Gynecol Oncol. .

Abstract

Introduction: Preoperative anemia is an established negative prognostic factor in gynecologic oncology patients, but is often underdiagnosed and undertreated. This quality-improvement initiative aimed to increase the identification and treatment of preoperative anemia in gynecologic oncology patients undergoing surgery at a tertiary centre.

Methods: This interrupted time-series study included all gynecologic oncology patients consenting for surgery between October 1, 2019 and November 1, 2021. Between October and December 2020, four interventions were implemented: surgical tracking, standardized preoperative anemia screening, staff training, and automatic referral to the Patient Blood Management (PBM) clinic. The primary outcome was preoperative anemia treatment rate using intravenous iron or erythropoiesis-stimulating agents. Secondary outcomes included hemoglobin (Hb) increase post-treatment, perioperative transfusion rate, postoperative nadir Hb and length of stay (LOS). Process measures were screening and PBM referral rates. Balancing measures included treatment complications and patient satisfaction.

Results: Among 499 pre-intervention and 574 post-intervention patients, 35 % (n = 361) had preoperative anemia. After intervention, treatment rates increased from 8 % to 39 % (p < 0.009) while transfusion rates decreased from 20 % to 12 % (p = 0.059). Screening increased from 2 % to 87 % (p < 0.00001) and PBM referral from 9 % to 97 % (p < 0.00001). Median preoperative Hb increased from 0 to 10 g/L post-treatment (p = 0.086). Median postoperative nadir Hb increased from 91 to 98 g/L (p = 0.148). No significant difference was found in LOS. No treatment associated complications were reported. Median post-intervention patient satisfaction score was 4/5.

Conclusion: Preoperative anemia is common in gynecologic oncology patients. Improved screening and treatment may increase preoperative and postoperative Hb and reduce transfusions without added complications.

Keywords: Gynecologic oncology; Intravenous iron; Patient blood management clinic; Preoperative anemia; Quality improvement; Surgery.

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Conflict of interest statement

Declaration of competing interest This study was presented as a poster presentation at the Society of Gynecologic Oncology of Canada (GOC), virtual (June 2021), which was awarded Best Poster Presentation. It was also presented as a poster presentation at the International Gynecologic Cancer Society (IGCS), virtual (Sept 2021), a poster presentation at the Society for Advancement of Patient Blood Management (SABM), virtual (Sept 2021), and an oral presentation at the Society of Pelvic Surgeons (SPS), New York, USA (June 2022). AC is the recipient of a grant from NCI, salary for expert testimony from CMPA and support for attending meetings from NRG Oncology. JC is the recipient of a grant from Canadian Blood Services and Octapharma for research funding, participates on advisory board meetings for Octapharma and for FEIST trial and is a board member of the Canadian Hematology Society. YL is the recipient of a grant from Canadian Blood Services and Octapharma for research funding, is a consultant for Choosing Wisely Canada, receives honoraria from Pfizer and is a board member of the Ontario Transfusion Coordinators Network.

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