Development and Evaluation of an Iron Deficiency Anemia Contextually Adapted Intervention in Gastrointestinal Surgery - Iron deficiency is a chronic medical condition for 1 in 8 adults in the general population,1 with an even higher prevalence in adults presenting for surgery. Although iron deficiency can exist with or without anemia,5 it most commonly manifests clinically as iron deficiency anemia (IDA), which is the the most frequent cause of anemia in patients prior to surgery affecting up to 75% of individuals depending on comorbidities and surgical indication. Indeed, a body of clinical trial data has demonstrated that supplemental iron improves fatigue, exercise capacity, and functional status and decreases surgical complications, length of stay, readmissions and need for blood transfusions. As a result of these data, multiple anesthesiology, surgical professional societies and the World Health Organization recommend routine perioperative testing for and treatment of IDA. Nevertheless, despite high quality evidence that perioperative iron supplementation improves outcomes, most surgical patients are not tested or treated for IDA. National data and preliminary findings from the Illiana Surgical Quality Improvement Collaborative (ISQIC) reveal that while 35% of elective surgical patients have anemia, fewer than 1% are tested for iron deficiency, and only 15% of those identified with IDA receive treatment. This represents a significant and persistent evidence-to-practice gap. The drivers of this gap are likely multifactorial and span system, provider, and patient levels, yet remain poorly understood. This project aims to develop and implement a scalable, contextually adapted intervention to improve perioperative IDA testing and treatment in diverse surgical settings. Aim 1 will assess baseline practice patterns and identify challenges, barriers, and needs related to IDA testing and treatment across ISQIC hospitals using mixed methods. Aim 2 will use the Consolidated Framework for Implementation Research (CFIR 2.0), participatory co-design, and the EPIS framework to develop a standardized protocol and workflow tailored to clinical contexts and stakeholder needs. Aim 3 will evaluate implementation quality (reach, adoption, fidelity) and clinical effectiveness (transfusion rates, length of stay, complications, readmissions) using the RE- AIM framework and a pre-post study design. This study will yield a generalizable, pragmatic strategy to close the IDA treatment gap in surgical patients. By embedding IDA optimization into routine surgical workflows, this intervention has the potential to improve patient safety, reduce healthcare costs, and serve as a scalable model for broader perioperative anemia management.
