title: Radical Cystectomy Perioperative Care Redesign.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address: Richard.matulewicz@northwestern.edu.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Matulewicz
authors.affiliation: Department of Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Brennan
authors.affiliation: Department of Urology, UNC School of Medicine, Chapel Hill, NC.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Shilajit D
authors.initials: SD
authors.lastname: Kundu
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
authors.affiliation: Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Meeks
mesh_terms: D015653:Cystectomy / Q000009:adverse effects; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004434:Early Ambulation; D004435:Eating; D019317:Evidence-Based Medicine; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control; D018529:Nutritional Support; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010353:Patient Education as Topic; D062526:Patient Navigation; D019990:Perioperative Care; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D004040:Dietary Carbohydrates