Cross-Sectional Survey on Perioperative Anemia Management in Major Abdominal Surgery: Current Practices and Resource Challenges Among Chinese Surgeons

Background Perioperative anemia remains a prevalent comorbidity among patients undergoing major abdominal surgery. The increasing surgical volume and proportion of complex abdominal resections in China have widened the gap between blood supply and clinical demand, necessitating more sophisticated perioperative anemia management. Despite its clinical significance, current perioperative anemia management practices in Chinese abdominal surgery remain largely undocumented. Objective This survey aimed to investigate the real-world perioperative anemia management practices among abdominal surgeons (gastrointestinal surgery and hepatobiliary pancreatic surgeons) in China and identify potential strategies to enhance perioperative anemia management quality in Chinese major abdominal surgery. Methods We conducted a nationwide survey through WeChat, distributing a comprehensive 48-item questionnaire to abdominal surgeons across China. The instrument evaluated five key domains: respondent demographics, perioperative anemia prevalence, detection and treatment approaches, and awareness and knowledge of new intravenous iron supplements. All responses were automatically captured and further analyzed. Results The survey included 519 validated responses from surgeons across all 34 provincial-level regions in Mainland China. The cohort comprised predominantly male surgeons (95%) with a median age of 43 years. Most respondents (80.9%) practiced in tertiary hospitals, with hepatobiliary-pancreatic specialists representing 76.9% of participants. Key findings revealed widespread recognition of the importance of perioperative anemia management, coupled with concerning blood resource limitations. Blood shortages prompted 67.8% (95%CI 63.8% - 71.8%) of surgeons to occasionally modify surgical plans, while 25.1%(95%CI 21.3% - 28.8%) reported frequent modifications. Preoperative anemia affected >10% of patients according to 62% of respondents, with iron deficiency anemia as the most prevalent etiology, exceeding 30% prevalence in 37.8% of respondents. Diagnostic practices showed room for improvement, with only 22.2% (95%CI 18.6% - 25.7%) routinely screening preoperative iron status. Treatment approaches varied, with 42.2% (95%CI 37.9% - 46.4%) using hemoglobin <70 g/L as the red blood cell transfusion threshold. Awareness and knowledge of intravenous iron supplements gaps existed, as 45.1% (95%CI 40.8% - 49.4%) of surgeons reported unfamiliarity with the administration protocols of intravenous iron supplements, and new intravenous iron supplement agents are not available in most hospitals. Nevertheless, strong interest emerged in safe and efficacious intravenous iron supplement agents. Conclusions This survey highlights significant perioperative anemia burdens in Chinese major abdominal surgery, exacerbated by blood resource constraints that impact clinical decision-making. Perioperative iron status monitoring remains underutilized, and knowledge gaps persist regarding intravenous iron supplement therapy. These findings underscore the need for enhanced continuing medical education and training focusing on anemia screening protocols and optimized iron supplementation strategies to improve perioperative anemia management quality in China.