Department of Urology, Ludwik Rydygier Memorial Specialized Hospital, Kraków, Poland.
Department of General and Oncologic Urology, Nicolaus Copernicus University, Bydgoszcz, Poland.
Adv Clin Exp Med. 2020 Mar;29(3):399-407. doi: 10.17219/acem/115085.
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.
老年人是最常接受择期泌尿外科手术的患者群体，由于合并症和虚弱，他们面临着最差手术结果的最高风险。目前的手术资格模式往往是主观的，并且基于的工具并不能解决老年人的特点。综合老年评估（CGA）和筛选工具可帮助评估年龄较大、特别是体弱的患者。本研究旨在回顾关于在接受泌尿外科治疗的患者中进行术前老年评估的文献。该综述基于 2000 年至 2017 年 MEDLINE/PubMed、Embase 和 Cochrane 图书馆全文英文出版物数据库，根据预先确定的标准选择前瞻性和回顾性研究。选择了 6 项前瞻性和 3 项回顾性研究进行进一步分析。患者人群、老年评估方法、干预措施和结局测量在研究之间存在差异。没有一项研究是随机对照试验。在 2 项研究中使用了 CGA；在其他研究中，使用了相当基本的筛选测试。仅在 2 项研究中，在 CGA 后进行了干预。总的来说，CGA 的变量是泌尿外科手术并发症的前瞻性和回顾性显著预测因素。尽管 CGA 的使用不是日常泌尿外科临床实践中的标准做法，但 CGA 的组成部分似乎可以预测术后并发症。因此，应考虑将老年评估作为老年泌尿外科患者常规术前护理的一部分。由于缺乏泌尿外科患者术前 CGA 的随机对照试验，需要进一步研究。
