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available at http://www.ncbi.nlm.nih.gov/pubmed/30359831 Editorial Comment: These authors propose that a patient undergoing major surgery should be optimized preoperatively, much like an athlete preparing for a marathon. In this interesting article they used a formal presurgical preparation program that focused on increased physical activity, pulmonary optimization, nutritional status and stress reduction. All patients underwent major colorectal surgery. A total of 40 patients who underwent formal preoperative rehabilitation were compared to 40 who underwent emergency surgery and 76 who underwent elective surgery without preoperative rehabilitation. The authors observed that patients who underwent preoperative training had improved intraoperative blood pressure and heart rate. The postoperative incidence of Clavien 3 and 4 complications was also improved in patients who underwent preoperative rehabilitative training (30%) compared to the emergency surgery group (48%) and the elective surgery group without training (38%). Thus, it would seem that a formal rehabilitation training program before elective surgery should be considered for all patients undergoing major surgery. At our institution patients are seen, evaluated and counseled during a formal preoperative visit at a dedicated preoperative clinic. It is likely that expanding this type of evaluation would benefit the patient undergoing major surgery. David S. Wang, MD DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE 7 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.