Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 3, March, p. 399–407

doi: 10.17219/acem/115085

Publication type: review article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Geriatric assessment among elderly patients undergoing urological surgery: A systematic literature review

Cyprian Michalik1,A,B,C,D,E, Kajetan Juszczak1,2,B,C,D,E, Piotr Maciukiewicz1,B,C,D,E, Tomasz Drewa2,3,E,F, Jakub Kenig4,A,C,D,E,F

1 Department of Urology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland

2 Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland

3 Department of General and Oncological Urology, Nicolaus Copernicus Hospital, Toruń, Poland

4 Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland

Abstract

The elderly constitute the group of patients who most often undergo elective urological procedures, and they are at the highest risk of poor surgical outcomes because of comorbidity and frailty. The current model of qualification for surgery is often subjective and based on tools which do not address the characteristics of the elderly. The Comprehensive Geriatric Assessment (CGA) and screening tools can help in the evaluation of older, particularly frail patients. The aim of the study was to review the literature on the usefulness of preoperative geriatric evaluation in patients undergoing urological treatment. The review was based on MEDLINE/PubMed, Embase and Cochrane Library bibliographic databases from 2000–2017 for full-text, English-language publications meeting pre-defined criteria. Six prospective and 3 retrospective studies were selected for further analysis. The patient populations, methods of geriatric assessment, interventions, and outcome measures varied between the studies. None of the studies were randomized controlled trials. In 2 studies, the CGA was used; in other studies, rather basic screening tests were used. In only 2 studies, an intervention was performed after the CGA. In general, the variables of the CGA were both prospectively and retrospectively significant predictors of complications of urological surgery. Although the use of CGA is not a standard practice in everyday urological clinical practice, components of the CGA appear to be predictive of postoperative complications. Therefore, inclusion of geriatric assessment as part of routine preoperative care in geriatric urology patients should be considered. Because of the lack of randomized controlled trials on preoperative CGAs in urology patients, further studies are needed.

Key words

elderly, preoperative assessment, frailty, geriatric assessment, urological surgery

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