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Does preoperative anemia affect surgical prognosis? Why?

2022.06.26 / Sunday
Does preoperative anemia affect surgical prognosis? Why?

There is still some controversy about the effect of preoperative anemia on surgical prognosis. This controversy often revolves around the incidence of preoperative anemia and postoperative complications and related mortality.

At present, the relevant evidence has mentioned the following three aspects, we will start from the following three aspects to explore the impact of preoperative anemia on postoperative.

These include, reduced oxygen-carrying capacity; increased risks associated with intraoperative transfusions; and potential postoperative complications.

1. Regarding the reduced oxygen-carrying capacity, we know that anemia actually restricts the delivery of oxygen to end-organs and may reduce ischemic tolerance of the patient's vital organs.
In addition to this, a study has demonstrated that providing adequate oxygen supply to patients during cardiopulmonary bypass can avoid the harmful effects of anemia in humans (including postoperative renal failure, etc.).
This is because hemoglobin is the most important oxygen carrier for peripheral organs, and this data should be kept above a critical threshold at all times. That is, increasing cardiac output or blood pump inflow during cardiopulmonary bypass can temporarily compensate for the effects of low hemoglobin in patients.

2. Regarding the possible increased risk associated with intraoperative blood transfusion, several retrospective studies have found that intraoperative blood transfusion is partially associated with inflammatory infections, renal failure, and increased mortality.
Since it is difficult to separate the increased risk of postoperative morbidity and mortality due to preoperative anemia from the risk associated with perioperative blood transfusion, in the current literature study, we can find that the existing conclusions also There is no evidence to prove it.

3. Anemia is common in patients with cardiovascular disease, heart failure, chronic lung disease, renal failure, diabetes, and cancer, and anemia may increase the incidence of postoperative complications and mortality in these patients.

However, there is no actual evidence to directly prove whether there is an indirect effect of anemia and surgical prognosis.