Overview of preoperative evaluation and preparation for gynecologic surgery
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
The preoperative evaluation and preparation prior to gynecologic surgery addresses issues that will potentially affect the woman during her surgical procedure and recovery. The surgeon should use this time to review the patient's history and physical examination, identify physical limitations, gather information required to plan surgery, optimize medical status, and educate about what to expect from the procedure and during the recovery period.
Many postoperative problems can be anticipated preoperatively, and eliminated or minimized; systematically addressing these issues at the preoperative evaluation may result in a shorter hospitalization with fewer complications and a more satisfied patient. The surgeon may also rethink the aggressiveness and necessity of a planned operative procedure after thoughtful discussion with patients who have severe medical problems. As an example, a woman with symptomatic congestive heart failure and uterine procidentia may be better served with a pessary than by vaginal hysterectomy and sacrospinous suspension. This discussion is mainly regarding scheduled surgery. Urgent cases require an expedited preoperative evaluation process to provide appropriate care.
The preoperative evaluation and preparation of women for gynecologic surgery will be reviewed here. General principles of preoperative evaluation and preparation are discussed separately. (See "Overview of the principles of medical consultation and perioperative medicine" and "Preoperative medical evaluation of the adult healthy patient".)
INFORMED CONSENT AND PATIENT EXPECTATIONS
The preoperative process should include comprehensive counseling of the patient regarding alternative treatment options (including expectant management) and risks and benefits of the procedure. For some procedures, particularly those that have variable outcomes and impact quality of life (eg, pelvic organ prolapse repair), patient expectations and goals should be discussed in detail. The expected duration and requirements of the recovery period should also be reviewed. Anticipatory guidance during preoperative office visits will enhance a patient's acceptance and compliance during the immediate postoperative period and may help to shorten hospital stay .
The surgeon should confirm that the patient has understood the discussion and desires to proceed with the procedure. This discussion should be documented in the medical record and on the procedure consent form.
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- INFORMED CONSENT AND PATIENT EXPECTATIONS
- PREOPERATIVE EVALUATION
- - Medical comorbidities
- Physical examination
- Laboratory tests
- - Pregnancy test
- - Testing for genital tract infection
- Other testing
- PREOPERATIVE PREPARATION
- Medication management
- Blood loss preparation
- - Correction of anemia
- - Autologous blood transfusion
- Wrong person, site, procedure prevention
- Smoking cessation
- Piercings and umbilical jewelry
- Intrauterine device
- SURGICAL SITE INFECTION PREVENTION
- Bundled interventions
- Antibiotic prophylaxis
- Skin preparation
- Vaginal preparation
- Other measures
- MEASURES FOR SELECTED USE OR THAT ARE NO LONGER RECOMMENDED
- Stress dose glucocorticoids
- Bowel preparation
- Endocarditis prophylaxis
- SPECIAL ISSUES
- Suspected malignancy
- Older adults
- Orthopedic issues or physical disabilities
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS