The expected outcome of the surgical procedure should be explained. If the procedure is being performed for diagnostic purposes, the outcome will depend on surgical or pathologic findings that are not known before surgery. When treating an anatomic deformity or disease, the expected success of the operation should be discussed, and the potential for failure of the operation (e.g., failure of tubal sterilization or the possibility that stress urinary incontinence may not be alleviated). When treating cancer, the possibility of finding more advanced disease and the potential need for adjunctive therapy (e.g., postoperative radiation therapy or chemotherapy) should be mentioned. Other issues of importance to the patient include discussion of loss of fertility or loss of ovarian function. These issues should be raised by the physician to ensure that the patient adequately understands the pathophysiology that may result from the surgery and to allow her to express her feelings regarding these emotionally charged issues. Unanticipated findings at the time of surgery should be mentioned. For example, if the ovaries are unexpectedly found to be diseased, the best surgical judgment may be that they should be removed.
4.
The risks and potential complications of the surgical procedure should be discussed, including the most frequent complications of the particular surgical procedure. For most major gynecologic surgery, the risks include intraoperative and postoperative hemorrhage, postoperative infection, venous thromboembolism, injury to adjacent viscera, and wound complications. The patient should understand that minimally invasive surgery may have many of the same risks of injury or complications as does “open” surgery. Given the potential for transfusion of blood products, it should be clarified whether the patient would object to receiving a transfusion. Preexisting medical problems (e.g., diabetes, obesity, chronic obstructive pulmonary disease [COPD], coronary artery disease) result in additional risks and should be reviewed with the patient. Measures that will be taken to reduce the risk of complications should be described (e.g., prophylactic antibiotics, bowel preparation, venous thromboembolism prophylaxis).
5.
The usual postoperative course should be discussed in enough detail to allow the patient to understand what to expect in the days following surgery. Information regarding the need for a suprapubic catheter, prolonged central venous monitoring, or an intensive care stay helps the patient accept her postoperative course and avoids surprises to the patient and her family that may be disconcerting. The expected duration of the recovery period, both in and out of the hospital, should be outlined.
6.
Alternative methods of therapy should be discussed, including medical management or other surgical approaches. The patient should have an understanding of the outcome of the disease if nothing is done.
Nutrition Young patients undergoing elective gynecologic surgery have adequate nutritional stores and, for the most part, do not require nutritional support. All patients should have a nutritional assessment, especially elderly patients and those undergoing gynecologic cancer surgery or other major gynecologic procedures in which a prolonged postoperative recovery is expected. Nutritional status should be reassessed at regular intervals postoperatively until the patient successfully returns to a regular diet.
A nutritional assessment includes a careful history and physical examination, which are the most useful, reliable, and cost-effective methods of determining a patient’s nutritional status. In particular, information about recent weight loss, dietary history, fad diets, extreme exercise, or anorexia or bulimia should be elucidated. Physical evidence of malnutrition includes temporal wasting, muscle wasting, ascites, and edema. Accurate height and weight measurements should be obtained and an ideal body weight, percentage ideal body weight, and percentage usual body weight may be calculated. Many Internet-based body weight calculators are available. A variety of techniques were developed to determine a patient’s nutritional state; however, many methods lack clinical utility outside of a research setting. Anthropometric measurements of skin-fold thickness and arm-muscle circumference provide an estimate of total body fat and lean muscle mass.
The calculated body mass index (BMI) can be used as a surrogate marker for nutritional status.