Perioperative Care and Optimization for GYN Patients

Today we’re featuring a special guest on the Podcast! Dr. Lauren Stewart is a current PGY-6 in Female Pelvic Medicine and Reconstructive Surgery here at Brown / Women and Infants. Lauren has special interest in perioperative care strategies in GYN, and has published a two-part series on the subject in “Topics in Obstetrics and Gynecology.”

It is a venti episode - a bit longer, but chock full of useful information!

While we can’t share Lauren’s articles directly due to paywall restrictions, you can find them here if your institution has a subscription: Part 1 and Part 2.

At the beginning of this episode, we discuss a number of systems you can utilize for preoperative evaluation of risk for patients, each with their own sets of pros and cons:
American Society of Anesthesiology (ASA) Physical Status Classification
Revised Cardiac Risk Index (RCRI)
American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator

In addition, ACOG does have some publications that can aide with your perioperative management:
-PB 195 - Preventing Infection after GYN Surgery
-CO 750 - Enhanced Recovery After Surgery (ERAS)
-PB 084 - Prevention of DVT/PE

The Caprini score we talk about in the podcast is a common tool for deciding on perioperative mechanical vs. pharmacological DVT prophylaxis, and is the scale recommended in the 2012 CHEST guidelines for VTE prophylaxis in non-orthopedic surgical patients. MD Calc has an excellent appraisal of the evidence as well as an interactive Caprini calculator for your use.

The Caprini score for VTE prevention in surgical patients

For antibiotic prophylaxis, this table from PB 195 is very handy review for CREOGs:

ACOG PB 195 - for further review of evidence, see full text.