2026 Southeastern Residency Conference

Evaluation of the Implementation of a Cardiothoracic Surgery Pre-Operative Anemia Treatment Protocol  

Alyan Saeed, Brendon Banes, Rebecka Hazelwood 
 
Background/Purpose: Patients undergoing cardiothoracic surgery (CTS) frequently present with baseline anemia, which has been associated with increased transfusion requirements, acute kidney injury (AKI), and higher postoperative morbidity and mortality. Prior studies suggest that pre-operative anemia optimization using intravenous iron, erythropoiesis-stimulating agents, and vitamin supplementation may reduce transfusion needs and improve surgical outcomes. In November 2023, Wellstar Kennestone Regional Medical Center (WKRMC) implemented a pre-operative anemia protocol for CTS patients with hemoglobin <12 g/dL; however, its clinical impact has not been formally evaluated. This study aimed to assess the efficacy and safety of the CTS pre-operative anemia protocol.  

Methods: This was an observational, retrospective chart review conducted at WKRMC evaluating adult patients (≥18 years) who underwent CTS between December 1, 2023 and September 1, 2025. Patients with a baseline hemoglobin <12 g/dL were grouped based on whether they received the pre-operative anemia treatment protocol prior to surgery. Patients were followed from three days prior to surgery through seven days post-operatively, hospital discharge, or death, whichever occurred first.   
The primary endpoint was the difference in post-operative hemoglobin levels between patients managed under the protocol and those in the non-protocol group. Secondary endpoints included number of post-operative red blood cell (RBC) units transfused and incidence of AKI within seven days. Safety outcomes included venous thromboembolism, stroke, post-operative infection, and hypersensitivity reactions to IV iron.  
Statistical analyses included paired and independent t-tests, along with Fisher’s exact test for categorical variables.  

Results: A total of 100 patients were included (protocol n=50, non-protocol n=50). Post-operative hemoglobin was similar between patients managed under the protocol and those receiving usual care (8.80 g/dL vs 9.07 g/dL, p=0.25). The mean number of RBC units transfused did not differ significantly between patients managed under the protocol and those receiving usual care (2.28 units vs 2.26 units, p=0.98). Post-operative AKI occurred less frequently in the protocol group compared to the non-protocol group (20% vs 36%, p=0.037). No significant differences were observed regarding the safety end points. There were no cases of IV iron hypersensitivity reactions in the protocol group.  

Conclusion: The pre-operative anemia protocol was associated with a lower incidence of post-operative acute kidney injury in CTS patients, while post-operative hemoglobin levels were similar between groups. These findings suggest that pre-operative anemia management may contribute to improved renal outcomes, despite comparable perioperative hematologic values.