Title : Pre-operative iron deficiency anaemia in colorectal cancer surgery: A missed oppurtunity for optimisation
Abstract:
Background: Anaemia prior to surgery for colorectal cancer is associated with increased morbidity and mortality. A significant proportion of patients will have anaemia secondary to iron deficiency, a symptom of colorectal cancer. National Institute of Health and Care Excellence (NICE) guidelines recommend that anaemic patients should undergo iron studies pre-operatively to ensure timely pre-operative optimisation.
Aim: To assess the adherence to NICE guidelines in the investigation and management of pre-operative iron deficiency anaemia in patients undergoing elective colorectal cancer surgery.
Methods: A retrospective review of all patients who underwent elective operations for colorectal cancer in a tertiary centre in the 6 months prior to March 2026. Patient records were analysed for the presence of pre-operative anaemia, investigation for iron deficiency anaemia and whether patients received oral or intravenous treatment for iron deficiency anaemia. Anaemia was defined using NICE criteria (Men Hb <130 and Females <120). Abstract Submission Template Exclusion criteria included patients with appendiceal tumours, who received adjuvant chemotherapy, or patients having operations for recurrent disease. Findings were then presented at a departmental meeting and a standardised approach to the recording is being implemented in colorectal cancer clinics.
Results: A total of 105 patients were identified, 61 male and 44 female, the incidence of anaemia was 41% (n=43/105). 56% (n=24) of anaemic patients had pre-operative iron studies performed, while 9% (n=4) had iron studies performed post-operatively. Iron deficiency anaemia was identified in 80% (n=22/28) in patients who had it recorded. Overall, 90% (n=20) of iron-deficient patients received treatment. Treatment rates were higher in patients identified pre-operatively (94%, n=17/18) compared to those identified post-operatively (75%, n=3/4). A larger cohort is required to determine statistical significance.
Conclusion: Treatment of iron deficiency anaemia is appropriately initiated when identified, preoperative investigations remain sub-optimal. A substantial proportion of anaemic patients do not undergo iron studies prior to surgery, representing a missed opportunity for optimisation of a potentially reversible condition. Education sessions with colorectal cancer nurses, and the introduction of a standardised anaemia protocol will be implemented to the unit, in order to improve identification of iron deficiency anaemia. Further analysis will evaluate whether pre-operative optimisation of anaemia improves haemoglobin levels and peri-operative outcomes.
