Radical Cystectomy Perioperative Care Redesign

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