Introduction/Background*Anaemia (haemoglobin <130g/l) is an established, independent risk factor for perioperative morbidity and mortality¹, the aetiology of which is diverse within in the gynaecological oncology population. We audited the management and consequences of perioperative anaemia in accordance with NICE guidelines² in a quaternary gynaecological oncology unit in London, United Kingdom (UK).

Methodology We performed a retrospective electronic case note review of women undergoing major (M) or major-plus (MP) gynaecological oncology surgeries between 1^stSeptember 2019 and 29^th February 2020. The category of operation was standardised at the unit.

Result(s)*Of 236 notes audited, 58.5% (n = 138) were anaemic pre-operatively.

87/236 patients underwent M surgery and 149/236 patients underwent MP surgery. The prevalence of anaemia was 43.7% in the M cohort (n=38) versus 67.1% in the MP cohort (n = 100). Mean Hb was the same between groups (113.4g/L vs. 113.4g/L). Only 4% (n=6) of patients had iron studies sent pre-operatively. No patients received an iron infusion pre-operatively, whilst 2.9% of patients had pre-operative blood transfusions.

The mean estimated blood loss (EBL) for all groups was 289.4ml. 53% of patients (n = 125) did not have any documented operative EBL. The overall incidence of post-operative blood transfusion was 24.6% (n=58). Women identified with pre-operative anaemia had a higher incidence of post-operative blood transfusion (anaemic 35.5% vs. non anaemic 9.2%).

Mean length of stay (LOS) was greater in anaemic M (3.4 vs.2.2 days) and MP (6.9 days vs. 5.1 days) procedures compared to their non-anaemic counterparts.

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Abstract 651 Figure 1

Post-operative transfusion incidence

Conclusion*Our analysis reveals a need for improvement in the management of peri-operative anaemia in our population. It also demonstrates the peri-operative consequences of untreated anaemia including a higher incidence of post-operative blood transfusion and increased LOS.

Our department is working to define a specific anaemia management pathway for all patients undergoing M or MP gynaecological surgery and we aim to undertake a randomised control trial to show our results.

• Musallam KM et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study Lancet. 2011 Oct 15;378(9800):1396-407. doi: 10.1016/S0140-6736(11)61381-0. Epub 2011 Oct 5.

National Institute for Health and Care Excellence. Perioperative care in adults; NICE guideline 2020 (Clinical guideline [NG180]). Available from https://www.nice.org.uk/guidance/ng180