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Frailty before colorectal surgery — SCE Geriatric Medicine MCQ

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HardFrailty and CGAFrailty before colorectal surgerySCE Geriatric Medicine

An 82-year-old is scheduled for major colorectal cancer surgery in 3 weeks. Haemoglobin is 92 g/L, ferritin 8 micrograms/L and transferrin saturation 9%; there is no haemodynamic instability. What is the best perioperative optimisation plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Investigate the iron deficiency concurrently and consider intravenous iron or postponement rather than relying on oral iron alone

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · C = shown as D · B = shown as E

A is correct: with major surgery inside 4 weeks, the CPOC pathway supports intravenous iron or consideration of postponement, while the cause of true iron deficiency is investigated in parallel. B overuses transfusion and invents a target. C overestimates the time available for oral iron and delays diagnosis. D confuses optimisation with permanent inoperability. E is physiologically and guideline-incongruent. The balance is time to benefit, surgical urgency and cause investigation.

Reference: CPOC: anaemia in the perioperative pathway: https://www.cpoc.org.uk/guidelines-and-resources/guidelines/anaemia-perioperative-pathway