Assessing anaemia screening and treatment in major elective colorectal surgical patients: a clinical audit

BackgroundPreoperative anaemia is associated with poor surgical outcomes, including increased transfusion rate. The National Blood Authority in Australia developed guidelines through patient blood management (PBM) to redress this issue.1 There is increasing use of iron infusion in the surgical setting, with associated adverse drug events including permanent skin discolouration and hypophosphataemia.AimThis project assessed: appropriateness of anaemia screening, use of iron, and impact on outcomes in major surgery associated with bleeding risk.MethodsA pharmacist‐led multi‐disciplinary team retrospectively reviewed 586 patients admitted for elective major colorectal surgery (DRG: G02A/B/C) in a metropolitan tertiary hospital, January 2016 to December 2018. An electronic audit tool was designed to collect: patient demographics (age, gender, private/public status), any anaemia screening within 6 weeks of surgery (haemoglobin and iron studies), pre/post‐operative use of iron (oral or intravenous) and postoperative outcomes (transfusion and hospital length of stay).ResultsFour hundred (68.3%) of 586 patients were preoperatively assessed for anaemia. Of these, 152 (38%) were classified as anaemic; and 38 (23.7%) of this anaemic group received preoperative iron. However, quality of preoperative anaemia assessment was poor, with only 34 (8.5%) of tested patients having PBM recommended iron studies, including ferritin, performed. Most anaemia assessments (43%) were conducted 0 to 1 day prior to surgery. This is insufficient for anaemia to be corrected. Two iron infusions were used in patients without anaemia. The perioperative transfusion rate was significantly higher in the anaemic group compared to the non‐anaemic group (Chi‐square: 19.7% vs 2.8%, p < 0.0001).ConclusionThis audit demonstrated that preoperative anaemia is poorly assessed and managed in colorectal surgical patients, potentially increasing surgical risk and health expenditure. Feedback to surgeons on the clinical impact of audit findings has improved their awareness of PBM guidelines. Pharmacists play a key role in improving surgical quality use of medicines.