Gynecologic Surgery and Perioperative Care
Core concepts
Perioperative care emphasizes risk assessment, prophylaxis, and complication prevention. Know preoperative evaluation (cardiac risk, anemia, glycemic control, VTE risk), antibiotic prophylaxis timing, thromboprophylaxis, and enhanced recovery principles. Understand surgical approaches (abdominal, laparoscopic, robotic, vaginal) and their trade-offs, plus common complications: hemorrhage, infection, VTE, bowel or urinary tract injury, and adhesions. Know postoperative fever evaluation and wound care.
Traps
- Antibiotic prophylaxis timing: administer within the appropriate window before incision; do not continue unnecessarily postoperatively for routine prophylaxis.
- VTE risk: gynecologic oncology and open surgery carry higher risk; use risk-appropriate prophylaxis.
- Postoperative fever: consider atelectasis, urinary infection, wound infection, and thrombophlebitis by postoperative day; do not anchor on a single cause.
- Bowel injury: may present insidiously after laparoscopy; maintain suspicion with unexplained pain or sepsis.
- Enhanced recovery: early feeding and ambulation improve outcomes; prolonged fasting and immobilization are avoided.
Worked example / rule of thumb
A patient undergoing open hysterectomy for suspected malignancy. Rule of thumb: combine mechanical and pharmacologic VTE prophylaxis for high-risk open pelvic surgery unless contraindicated, and time antibiotic prophylaxis before incision.
Study strategy
Build a preoperative checklist and a postoperative complication timeline; these cover most surgical stems.