Reducing Postoperative Blood Tests in Colorectal Surgery: A Dual-Cohort Before-and-After Study

Routine postoperative blood testing is a deeply ingrained aspect of colorectal surgical ward practice, yet a significant proportion of tests ordered are not clinically indicated. Overtesting contributes to iatrogenic anemia, increased costs, and patient discomfort. Compliance with Enhanced Recovery After Surgery (ERAS) Society and National Health Service (NHS) England guidance on blood test rationalization is inconsistent, particularly in acute surgical settings, which have received little specific interventional attention.

A dual-cohort, before-and-after interventional study was conducted in a single NHS colorectal unit. Cohort 1 comprised consecutive elective colorectal resection patients (n = 31 per period), assessed against ERAS Society guidelines (2018). Cohort 2 comprised acute colorectal inpatients (n = 20 per period), assessed against NHS England blood testing guidance (2021). Interventions comprised targeted staff education, a visual traffic-light ward poster specifying recommended testing schedules, and a structured ward round proforma blood test section (acute cohort). Postintervention data were collected after a 3-mo interval.

In the elective cohort, routine postoperative day 2 blood testing fell from 90% to 26% (P < 0.001), representing a 71% relative reduction, with ERAS-compliant testing improving from approximately 30% to 95%. In the acute cohort, total blood tests decreased from 905 to 335 (63% reduction), and clinically unnecessary tests decreased from 58.3% to 23.3% (P < 0.001). The greatest reductions were observed for phosphate (95.5%), magnesium (95.2%), and bone profile (91.8%). No immediate adverse patient safety signals were identified in either postintervention period.

Simple, low-cost educational and environmental interventions were associated with improved guideline compliance in both elective and acute colorectal surgical settings without identified adverse patient safety signals. Acute colorectal patients represent a neglected target for ERAS implementation, with markedly elevated rates of nonindicated blood test ordering. These findings support wider adoption of indication-based blood test requesting across colorectal surgical practice.