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

The Preoperative Assessment and Optimization of Patients Undergoing Major Urological Surgery.

Author information

1
Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK. helen.cui@nds.ox.ac.uk.
2
Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford, UK.
3
Nuffield Department of Anaesthetics, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.

Abstract

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.

KEYWORDS:

CPET; Cystectomy; Nephrectomy; Nephroureterectomy; Preoperative assessment; Urological surgery

PMID:
28589402
PMCID:
PMC5486597
DOI:
10.1007/s11934-017-0701-z
[Indexed for MEDLINE]
Free PMC Article

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