Radical Cystectomy Perioperative Care Redesign

Richard S. Matulewicz, Jeffrey Brennan, Raj S. Pruthi, Shilajit D Kundu, Chris M. Gonzalez, Joshua J Meeks

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Objective To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. Methods A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative. Preference was given to evidence from prospective randomized trials, meta-analyses, and systematic reviews. Results Preoperative considerations to improve care in the RC patient should include multi-disciplinary medical optimization, patient education, and formal coordination of care. Efforts to mitigate the risk of malnutrition and reduce postoperative gastrointestinal complications may include carbohydrate loading, protein nutrition supplementation, and avoiding bowel preparation. Intraoperatively, a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus. Finally, enhanced recovery protocols including novel medications, early feeding, and multi-modal analgesia approaches are associated with earlier postoperative convalescence. Conclusion RC is a complex and morbid procedure that may benefit from care redesign. Evidence based quality improvement is integral to this process. We hope that this review will help guide further improvement initiatives for RC.

Original languageEnglish (US)
Pages (from-to)1076-1086
Number of pages11
JournalUrology
Volume86
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Perioperative Care
Cystectomy
Fluid Shifts
Intestinal Pseudo-Obstruction
Patient Education
Quality Improvement
PubMed
Malnutrition
Analgesia
Opioid Analgesics
Meta-Analysis
Databases
Proteins

ASJC Scopus subject areas

  • Urology

Cite this

Matulewicz, R. S., Brennan, J., Pruthi, R. S., Kundu, S. D., Gonzalez, C. M., & Meeks, J. J. (2015). Radical Cystectomy Perioperative Care Redesign. Urology, 86(6), 1076-1086. https://doi.org/10.1016/j.urology.2015.09.001
Matulewicz, Richard S. ; Brennan, Jeffrey ; Pruthi, Raj S. ; Kundu, Shilajit D ; Gonzalez, Chris M. ; Meeks, Joshua J. / Radical Cystectomy Perioperative Care Redesign. In: Urology. 2015 ; Vol. 86, No. 6. pp. 1076-1086.
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Matulewicz, RS, Brennan, J, Pruthi, RS, Kundu, SD, Gonzalez, CM & Meeks, JJ 2015, 'Radical Cystectomy Perioperative Care Redesign', Urology, vol. 86, no. 6, pp. 1076-1086. https://doi.org/10.1016/j.urology.2015.09.001

Radical Cystectomy Perioperative Care Redesign. / Matulewicz, Richard S.; Brennan, Jeffrey; Pruthi, Raj S.; Kundu, Shilajit D; Gonzalez, Chris M.; Meeks, Joshua J.

In: Urology, Vol. 86, No. 6, 01.12.2015, p. 1076-1086.

Research output: Contribution to journalReview article

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AU - Matulewicz, Richard S.

AU - Brennan, Jeffrey

AU - Pruthi, Raj S.

AU - Kundu, Shilajit D

AU - Gonzalez, Chris M.

AU - Meeks, Joshua J

PY - 2015/12/1

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N2 - Objective To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. Methods A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative. Preference was given to evidence from prospective randomized trials, meta-analyses, and systematic reviews. Results Preoperative considerations to improve care in the RC patient should include multi-disciplinary medical optimization, patient education, and formal coordination of care. Efforts to mitigate the risk of malnutrition and reduce postoperative gastrointestinal complications may include carbohydrate loading, protein nutrition supplementation, and avoiding bowel preparation. Intraoperatively, a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus. Finally, enhanced recovery protocols including novel medications, early feeding, and multi-modal analgesia approaches are associated with earlier postoperative convalescence. Conclusion RC is a complex and morbid procedure that may benefit from care redesign. Evidence based quality improvement is integral to this process. We hope that this review will help guide further improvement initiatives for RC.

AB - Objective To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative. Methods A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search. Specific topics were reviewed within the scope of the three major phases of perioperative management: preoperative, intraoperative, and postoperative. Preference was given to evidence from prospective randomized trials, meta-analyses, and systematic reviews. Results Preoperative considerations to improve care in the RC patient should include multi-disciplinary medical optimization, patient education, and formal coordination of care. Efforts to mitigate the risk of malnutrition and reduce postoperative gastrointestinal complications may include carbohydrate loading, protein nutrition supplementation, and avoiding bowel preparation. Intraoperatively, a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus. Finally, enhanced recovery protocols including novel medications, early feeding, and multi-modal analgesia approaches are associated with earlier postoperative convalescence. Conclusion RC is a complex and morbid procedure that may benefit from care redesign. Evidence based quality improvement is integral to this process. We hope that this review will help guide further improvement initiatives for RC.

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Matulewicz RS, Brennan J, Pruthi RS, Kundu SD, Gonzalez CM, Meeks JJ. Radical Cystectomy Perioperative Care Redesign. Urology. 2015 Dec 1;86(6):1076-1086. https://doi.org/10.1016/j.urology.2015.09.001