Perioperative Anemia Investigation and Management in Vascular Surgery: A Single-Center Retrospective Service...

Background Perioperative anemia is common in vascular surgery, but it is unclear how well national guidelines are followed in its investigation. This service evaluation examined how closely routine vascular surgical practice adhered to the British Society for Haematology (BSH) recommendations for investigating iron deficiency. Methods A retrospective service evaluation of consecutive adults undergoing vascular surgery at a single NHS center was performed. Electronic records were reviewed to determine the prevalence of preoperative anemia, adherence to the BSH recommendations for iron deficiency investigation, perioperative iron therapy, transfusion, and postoperative hemoglobin recovery. Exploratory comparisons were made by preoperative anemia status. Results Fifty-seven patients were included in the evaluation, and preoperative hemoglobin levels were documented for 53/57 patients (93.0%), of whom 32/53 (60.4%) were anemic (hemoglobin <130 g/L). Among patients with anemia, ferritin was measured in 14/32 (43.8%), but only 8/32 (25.0%) underwent a complete iron deficiency assessment. Iron therapy was initiated during the perioperative episode in 9/57 patients (15.8%). Nine patients (9/57, 15.8%) received a postoperative RBC transfusion, of whom 8/9 (88.9%) had preoperative anemia. Patients with preoperative anemia had a lower postoperative hemoglobin nadir than those without anemia (median 87 vs 126 g/L; Mann-Whitney U = 530.5; p < 0.001). Hemoglobin recovery was assessable in 35/57 patients (61.4%), of whom 22/35 (62.9%) had documented recovery to at least their preoperative concentration during available follow-up. Conclusions Preoperative anemia was common in this cohort, but investigation of its underlying cause was often incomplete. Only 8/32 patients with anemia (25.0%) underwent a complete iron deficiency assessment, hindering the classification of iron status and the provision of cause-directed management. Improving adherence to a structured diagnostic pathway is the principal opportunity for local quality improvement.