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

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Francesca Malcolm ◽  
Furqaan Kaji ◽  
Lisa Shelswell ◽  
William Speake ◽  
Sarah Liptrot ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Patient Group ◽  
Secondary Outcome ◽  
Day Case ◽  
Colorectal Cancer Surgery ◽  
Anaemic Patient ◽  
Mortality And Morbidity ◽  
Anaemia Management ◽  
Iv Iron

Abstract 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.

scholarly journals 521 Optimising Anaemic Patients for Colorectal Cancer Surgery: Implementation of Day-Case Iron Infusion Pathway and Closed Loop Audit of Anaemia Management in Colorectal Cancer Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F Malcolm ◽  
F Kaji ◽  
L Shelswell ◽  
B Plummer ◽  
W Speake ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Patient Group ◽  
Secondary Outcome ◽  
Day Case ◽  
Colorectal Cancer Surgery ◽  
Anaemic Patient ◽  
Mortality And Morbidity ◽  
Anaemia Management ◽  
Iv Iron

Abstract Aim 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. Method 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 cycle’s 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.

scholarly journals A cohort investigation of anaemia, treatment and the use of allogeneic blood transfusion in colorectal cancer surgery

2016 ◽  
Vol 6 ◽  
pp. 6-11 ◽  
Author(s):  
Barrie D. Keeler ◽  
Amitabh Mishra ◽  
Christiana L. Stavrou ◽  
Sophia Beeby ◽  
J. Alastair Simpson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Cancer Surgery ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
Colorectal Cancer Surgery

MODULATION OF IMMUNE RESPONSE BY BLOOD TRANSFUSION: EVIDENCE FOR A DIFFERENTIAL EFFECT OF ALLOGENEIC AND AUTOLOGOUS BLOOD IN COLORECTAL CANCER SURGERY

Shock ◽  
1997 ◽  
Vol 8 (6) ◽  
pp. 402-408 ◽  
Author(s):  
Markus M. Heiss ◽  
Peter Fraunberger ◽  
Christian Delanoff ◽  
Regine Stets ◽  
Heike Allgayer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Immune Response ◽  
Blood Transfusion ◽  
Differential Effect ◽  
Autologous Blood ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery

Blood transfusion and infection after colorectal cancer surgery

Transfusion ◽  
1996 ◽  
Vol 36 (11-12) ◽  
pp. 1000-1008 ◽  
Author(s):  
E. C. Vamvakas ◽  
J. H. Carven ◽  
P. L. Hibberd
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery

scholarly journals Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer

2019 ◽  
Vol 27 (3) ◽  
pp. 833-843 ◽  
Author(s):  
Stephen T. McSorley ◽  
Alexander Tham ◽  
Ross D. Dolan ◽  
Colin W. Steele ◽  
Jason Ramsingh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Blood Transfusion ◽  
Propensity Score ◽  
Inflammatory Response ◽  
Elective Surgery ◽  
Systemic Inflammatory Response ◽  
Cancer Specific Survival ◽  
Colorectal Cancer Surgery ◽  
Perioperative Blood Transfusion

Abstract Background The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96–221 mg/L] vs. 120 (IQR 72–188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 27 (IQR 24–30 g/L); p < 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03–5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08–4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93–196 mg/L) vs. 113 (IQR 66–173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 26 (IQR 24–30 g/L); p < 0.001], more postoperative complications (OR 2.91, 95% CI 1.36–6.20) and poorer OS (HR 2.38, 95% CI 0.99–5.73). Conclusions Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques.

Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery

The Lancet ◽  
1993 ◽  
Vol 342 (8883) ◽  
pp. 1328-1333 ◽  
Author(s):  
M.M. Heiss ◽  
K-W. Jauch ◽  
C. Delanoff ◽  
G. Mayer ◽  
F-W. Schildberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Beneficial Effect ◽  
Autologous Blood ◽  
Infectious Complications ◽  
Cancer Surgery ◽  
Autologous Blood Transfusion ◽  
Colorectal Cancer Surgery

scholarly journals TP10.2.7Reintroduction of elective colorectal cancer surgery following the first wave of Covid-19 in the UK – an audit of risk mitigation strategies and review of patient outcome

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Francesca Malcolm ◽  
James Chean Khun Ng ◽  
William Speake
Keyword(s):  
Colorectal Cancer ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Colorectal Cancer Surgery ◽  
Mortality And Morbidity ◽  
Defunctioning Ileostomy ◽  
Operative Strategies ◽  
Risk Mitigation Strategies ◽  
The Uk ◽  
The Impact

Abstract Aim Perioperative acquisition of Covid-19 is associated with high mortality and morbidity. We have analysed the effectiveness of newly designed ‘green’ pathway for elective colorectal cancer (CRC) patients, which aimed to minimise risk of Covid-19. Method Data collected with concurrent implementation of ‘green’ pathway for all patients undergoing CRC surgery over a 6 week period following the ‘first wave’ of the Covid-19 pandemic. The standard audited were appropriately timed pre-operative CT chest, Covid-19 swabs and shielding adherence. The impact of positive pre-operative swabs and post-operative complications were analysed. Additional risk mitigation strategies included dual consultant operating, open operating, and defunctioning ileostomy for high risk anastomoses. Results 49 operations performed of 56 planned. 1 cancelled due to patient being positive for Covid-19, 5 due to progression of cancer on restaging CT, 1 required further medical optimisation. All had a 2 week pre-operative swab and then shielded until the day of the operation. 48/49 had swab 2 days pre-op. CT chest performed in all, 37 (66.7%) were to restage. 4 (8%) had post-operative complication graded as ≥ 2 on Clavien-Dindo score; none of which were Covid related. 1 patient tested positive for Covid-19 post-operatively but remained asymptomatic. All procedures were open and performed by 2 consultants. Conclusion We demonstrate an effective pathway and various operative strategies which can be employed to reduce risk for patients undergoing CRC surgery in the midst of the ongoing global pandemic.

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