The Preoperative Assessment and Optimization of Patients Undergoing Major Urological Surgery

Cui HW, Turney BW, Griffiths J.

Curr Urol Rep. 2017 Jul;18(7):54. doi: 10.1007/s11934-017-0701-z

PURPOSE OF REVIEW: Improving patient outcomes from major urological surgery
requires not only advancement in surgical technique and technology, but also the
practice of patient-centered, multidisciplinary, and integrated medical care of
these patients from the moment of contemplation of surgery until full recovery.
This review examines the evidence for recent developments in preoperative
assessment and optimization that is of relevance to major urological surgery.
RECENT FINDINGS: Current perioperative medicine recommendations aim to improve
the short-term safety and long-term effectiveness of surgical treatments by the
delivery of multidisciplinary integrated medical care. New strategies to deliver
this aim include preoperative risk stratification using a frailty index and
cardiopulmonary exercise testing for patients undergoing intra-abdominal surgery
(including radical cystectomy), preoperative management of iron deficiency and
anemia, and preoperative exercise intervention. Proof of the utility and validity
for improving surgical outcomes through advances in preoperative care is still
evolving. Evidence-based developments in this field are likely to benefit
patients undergoing major urological surgery, but further research targeted at
high-risk patients undergoing specific urological operations is required.