Committed to be fit. The value of preoperative care in the perioperative medicine era

Tailoring prehabilitation to address the multifactorial nature of functional capacity for surgery

“…Examples include cancer-related malnutrition as a result of malabsorption or inadequate intake, neoadjuvant treatments that impair erythropoiesis, gastrointestinal blood losses (e.g., colorectal cancer) or the concomitant proinflammatory state created by the disease itself. 29,30 Relationship between anaemia and functional status Functional capacity can be affected by two interrelated conditions, anaemia and iron deficiency, that overlap in iron deficiency anaemia, which is the most common type of anaemia observed preoperatively. 29 Anaemia affects the oxygen carrying capacity, which impairs aerobic capacity by creating an imbalance between oxygen demand with the ability of the oxygen transportation system (i.e., Hgb) to deliver oxygen to the tissues.…”

“…29,30 Relationship between anaemia and functional status Functional capacity can be affected by two interrelated conditions, anaemia and iron deficiency, that overlap in iron deficiency anaemia, which is the most common type of anaemia observed preoperatively. 29 Anaemia affects the oxygen carrying capacity, which impairs aerobic capacity by creating an imbalance between oxygen demand with the ability of the oxygen transportation system (i.e., Hgb) to deliver oxygen to the tissues. The ability to perform increasingly demanding aerobic exercise, such as with CPET, is mostly achieved by the simultaneous increase in cardiac output (stroke volume × heart rate) and an increase in the arteriovenous oxygen content difference (CaO 2 -CvO 2 ), which is mainly dependent on Hgb content.…”

“…40 Intravenous iron should also be considered when surgery is planned in less than 6 weeks or in patients in whom oral absorption will be impaired, which is common in proinflammatory states and in functional iron deficiency. 29 The amount of intravenous iron required can be calculated with the following formula: total iron dose (mg) = (target Hgb − baseline Hgb [g L -1 ]) × 0.24 × body weight (kg) + 500 for iron stores. 40 Different intravenous iron preparations are available, with a good safety profile overall and low adverse events.…”

“…But, most importantly, factors related to the disease for which the patient is being treated can trigger or exacerbate anaemia. Examples include cancer‐related malnutrition as a result of malabsorption or inadequate intake, neoadjuvant treatments that impair erythropoiesis, gastrointestinal blood losses (e.g., colorectal cancer) or the concomitant proinflammatory state created by the disease itself 29,30 …”

“…Functional capacity can be affected by two interrelated conditions, anaemia and iron deficiency, that overlap in iron deficiency anaemia, which is the most common type of anaemia observed preoperatively 29 . Anaemia affects the oxygen carrying capacity, which impairs aerobic capacity by creating an imbalance between oxygen demand with the ability of the oxygen transportation system (i.e., Hgb) to deliver oxygen to the tissues.…”