EP1060 - "How Stale are your Labs?" - Hemoglobin Lab Recency and Post-Operative Morbidity & Mortality in Colorectal Cancer Patients

Monday, May 11, 2026

3:35 PM - 3:40 PM ET

ePoster Presenter(s)

Ali M. Farooqui, MS, MD

Colorectal Surgery Research Fellow
University of Illinois - Chicago
University of Illinois - Chicago
Chicago, IL, United States

Disclosure information not submitted.

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Author(s)

HITESH KAPOOR, MBBS

Research Fellow
University Of Illinois Chicago
University of Illinois Chicago
CHICAGO, IL, United States

Disclosure information not submitted.
Gustavo R. Parra Vitela, Medical Doctor

Research Specialist
University of Illinois in Chicago
University of Illlinois at Chicago
Chicago, IL, United States

Disclosure information not submitted.
EB

Elisa Bianchi, MD

Colorectal Surgeon
University of Illinois at Chicago
chicago, Illinois, United States

Disclosure information not submitted.
MA

Mohamad A. Abdulhai, MD

Assistant Professor of Surgery
University of Illinois at Chicago College of Medicine
Chicago, Illinois, United States

Disclosure information not submitted.
VC

Vivek Chaudhry, MD, FACS, FASCRS

Clin Prof of Surgery
University of Illinois
Chicago, Illinois, United States

Disclosure information not submitted.

Senior Author(s)

GG

Gerald Gantt, MD

Associate Professor of Surgery
University of Illinois Chicago
Chicago, Illinois, United States

Disclosure information not submitted.

Purpose/Background: Anemia is common in colon cancer patients due to chronic blood loss from the tumor, and from systemic inflammation that leads to impaired iron metabolism and reduce red blood cell production. International guidelines (including ERAS and ICCAMS) stress the need for preoperative evaluation and effective treatment of anemia, advocating a hemoglobin (Hgb) cutoff of 13.0 g/dL for screening to allow at least 4 weeks for effective therapy. However, definitive evidence-based recency thresholds for laboratory testing are currently missing. We aimed to define the time window that separates actionable, high-risk anemia from historical, non-predictive findings in patients undergoing elective surgery for colon cancers.

Methods/Interventions: A retrospective cohort study was performed using the 2023 ACS NSQIP PUF. The data were analyzed using the R statistical software environment. The cohort was filtered to include colon cancer patients (ICD-10 C18.**) who underwent elective surgeries for the cancer (N = 16100 cases). This analysis utilized a variable unique to the 2023 PUF which represents the number days between which a Hgb lab value was drawn and the day of surgery. The primary outcome was composite serious morbidity/30-day mortality. We constructed a Hgb x Recency model using 28 days as a cutoff. Adjusted odds ratios (AOR) were calculated via multivariable logistic regression.

Results/Outcomes: Patients with abnormal Hgb at 28 days or less were the only group to show a statistically significant risk increase. This profile was associated with 63% higher odds of complication (AOR = 1.63, p < 0.05). The increased risk for abnormal Hgb was sustained but not significant when the lab was older than 28 days (AOR 1.59, p = 0.108).

Conclusion/Discussion: The data provides evidence that the 28-day mark is the critical threshold for implementing immediate intervention. We recommend institutions focus mandatory, aggressive optimization on patients whose Hgb < 13.0 g/dL is confirmed within the 28-day window. Conversely, patients with abnormal labs older than 28 days demonstrate that the acute, predictive risk has expired, and it is likely these patients are optimized far ahead of their scheduled elective surgeries. This policy aligns with ERAS goals by matching intensive intervention to the proven risk window.