Optimizing Pre-operative Patient Factors to Reduce Post-Surgical Complications

Pei-Shan YangTaiwan Speaker Optimizing Pre-operative Patient Factors to Reduce Post-Surgical ComplicationsOptimizing Pre-operative Patient Factors to Reduce Post-surgical Complications Preoperative care • Preoperative documentation • Assessment of physical function and frailty • Cognititve screening • Pulmonary risk • Cardiovascular risk • Elective urological surgery should be delayed for 14 days after coronar balloon angioplsty, 30 days after bare metal stent 1 year after drug-eluting implantation • Atrial fibrillation do not need bridge therapy except for high risk of stroke, venous thrmoembolism <12 wks recent stenting or chronic anticoagulation • Endocrine • Delay elective procedure for HbA1C>6.9% • Longterm steriod dose adjustment for risk of GI bleeding or reactive airway issues • GI • Preoperaive fasting (6hrs befoere GA for solids, 2 hrs for clear liquids) is recommended to reduce the risk of intraoperative aspiration • Renal • ESRD: evaluate for hyperkalemia, acid-base status, anemia • Consider antibiotics covering endocarditis for dialysis patients • Nutrition • Immunonutrition (IMN) • Some equivocal results • lower postop infectious copmlications but no diff in other outcomes • Earlier return to bowel function with IMN but no diff in other outcomes • There was no difference in any grade CD complications by type of nutritional supplement for patients with bladder cancer undergoing RC. • From SWOG s1600 • Endourology • Scoring system • Novel techniques for puncture planning • Prevention of ureteral injury • Stenting •