Authors: Crispell E et al.
Anesthesia & Analgesia 141(5):964–974, Nov 2025 DOI: 10.1213/ANE.0000000000007435
Summary
This descriptive observational study outlines the development, launch, and staged expansion of a multidisciplinary preoperative anemia clinic (PAC) at a large tertiary medical center. Preoperative anemia is common, strongly associated with adverse surgical outcomes, and treatable — yet many institutions lack a structured pathway to diagnose and optimize these patients. The goal of this project was to provide a practical framework for designing a functional PAC and to report early clinical experience.
The PAC was created in 2019 with broad institutional support, including anesthesiology, surgery, internal medicine, nursing, project management, informatics, and systems engineering. Initially focused on cardiac surgery patients, the PAC expanded in planned stages to other specialties. Key implementation components included identification of target populations, establishing treatment algorithms, EHR integration, clinic workflow design, laboratory/data pipelines, and training of all participating clinicians.
Over the study period, the PAC evaluated 1159 unique patients (1188 encounters). Median age was 66 years, and women comprised 58.1%. Iron deficiency accounted for the majority of anemia cases (69.1%), followed by cancer-related anemia (17.3%). Anemia-directed treatment was recommended for 87.4% of encounters, and 70.3% of those patients received treatment prior to surgery. Intravenous iron was the dominant therapy (97.1% of treated cases), with erythropoiesis-stimulating agents used in 20%.
A subset of patients completed patient-reported outcomes before and after PAC implementation. Although not statistically compared due to small sample sizes, the post-PAC group appeared to have faster improvement in anemia symptoms and less deterioration in postoperative well-being.
Overall, the PAC was shown to be feasible, scalable, and effective in initiating treatment for the majority of patients. The authors provide a roadmap that other centers can use to build similar programs, emphasizing the importance of multidisciplinary collaboration and deliberate, staged implementation.
What You Should Know
• Structured preoperative anemia clinics are rare but highly needed.
• This study provides a step-by-step blueprint for designing and implementing a PAC.
• 1159 unique patients evaluated over four years; most had iron deficiency.
• 87% were eligible for treatment; 70% received therapy before surgery.
• Intravenous iron was the primary intervention.
• Early patient-reported outcomes suggest improved symptom resolution and better postoperative well-being.
• PAC development requires strong multidisciplinary involvement and EHR integration.
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