Review Article: Preoperative Evaluation and Optimization of the Geriatric Urological Patient

Geriatric urological patients are at higher risk for postoperative morbidity and mortality compared to their younger counterparts because of an increased prevalence of comorbidities and functional impairments. A comprehensive preoperative evaluation is necessary to identify and address these issues, as well as to optimize perioperative physiological and functional status.

The presence of frailty in geriatric patients is an especially important indicator of increased perioperative surgical risk but frailty screening is poorly addressed in the majority of guidelines on preoperative screening. Geriatric patients are categorized as frail, pre-frail or nonfrail. Preoperative evaluation of these patients should include nutritional status, a psychosocial assessment, and assessment of aftercare and social support.

Routine preoperative laboratory and radiographic evaluations are not recommended based solely on age. Rather, an individualized, pragmatic approach founded on the preoperative assessment, evidence-based guidelines, and the nature and extent of the surgery is advised.

Following these recommendations will provide the urologist a thorough and practical approach to the preoperative evaluation of geriatric urological patients, with the ultimate goal of reducing perioperative morbidity and mortality.