Anemia – Anemia (low red cell blood count) is seen in about 30% of patients presenting for surgery and is a risk factor for complications but so is the administration of blood-products. Optimizing the red cell count before surgery without transfusion is then the best option and this can be done by providing oral or intravenous iron or intravenous erythropoietin (a hormone produced by the kidney that stimulates red blood cell production in the bone marrow). Exercise – Reduced exercise capacity before surgery is a risk factor for postoperative complications and long-term disability. Exercise training prior to surgery may therefore improve outcomes by allowing the body to tolerate greater levels of stress. Although moderate exercise such as walking might be easier to accomplish given sufficient time, the shorter time period from decision to surgery to actual surgery date means that a supervised high- intensity interval training programs over 3-4 weeks may be the best choice. [6] While it is clear that such exercise will improve functional capacity, studies to determine whether preoperative exercise will change postoperative outcomes are underway but have not been completed. Nutrition – It is estimated that more than one in every three hospitalized patients is malnourished at admission and that only 3% of these patients are being properly identified and treated. The surgical stress response, which can result in muscle breakdown, increases protein requirements even further. Thus, patients at risk of malnutrition should receive high-protein oral nutritional supplements for 2-4 weeks prior to surgery. [7]
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