SP1.1.8Optimising anaemic patients for colorectal cancer surgery: implementation of day-case iron infusion pathway and closed loop audit of anaemia management

Aims Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion. Methods Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycles education regarding anaemia management and further publicity of the iron infusion pathway took place within the department. Results In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron. Conclusions We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However these is still room for improvement in management of anaemia within this patient group.