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1. Prevention of Infection Following G

necological Surger

resu

ts in a s

ner

istic increase in ot

er or

anisms suc

as Mo

uncus s

more anaero

es. T

e resu

t is a po

micro

ance o

e num

ers o

potentially pathogenic organisms, yet no cellular inﬂ

ammatory response. This

con

ition is ca

acteria

inosis (BV) [2]. As a resu

t, t

e causative or

isms o

postoperative in

ectious mor

are rare

unimicro

or exo

enous or

anisms and are more likel

to be pol

microbial and endo

enous

anisms, suc

as t

e po

micro

con

ition o

BV or BV-re

ate

anisms,

., anaero

es,

uncus

cop

asmas, an

ureap

asmas

n 2001, t

e C

inica

ectiveness Grou

e Association

or Genitouri

nar

icine an

e Me

ica

Societ

or t

e Stu

Venerea

Diseases

pro

uce

nationa

ines

or t

e mana

ement o

BV. T

iste

e com-

ications associate

wit

BV as posta

orta

sepsis, post-

ysterectomy vagina

itis, an

scess post–vagina

ysterectomy. T

ey conc

(

eve

evi

ence A) t

at treatment was in

icate

or s

mptomatic women, some

pre

nant women, an

women un

oin

some sur

ica

proce

ures. Most o

e evi

ence pertainin

to t

e use o

anti

iotics in women un

oin

sur

ates to

sterectom

sur

ica

TOP as an examp

e o

transva

ina

mani

ation o

e uterus.

rophylact

c Ant

cs for Hysterectomy

aginal Hysterectom

irsch [3] reviewed those studies in which antibiotics were used prophy

lactically in women undergoing vaginal hysterectomy. As early as 1985, Hirsch

was able to ﬁ

nd 48 studies of 5524 patients, of whom 3037 had been treated

and 2487 were used as controls. Febrile morbidity occurred in 444 (15%) of

037 women who received antibiotics compared to 988 (40%) of 2487 women

who did not receive antibiotics (relative risk [RR]

0.37; 95% conﬁ

dence

nterval [CI]

0.33–0.41;

0.01). Similarly, pelvic infections occurred in

05 (5%) o

2099 women w

o receive

anti

iotics compare

to 354 (25%)

1391 women w

not receive anti

iotics (RR

0.2;

0.1

–0.24;

0.01).

bdom

nal Hysterectom

s part of the same review [3], Hirsch reviewed those studies in which

antibiotics were used proph

lacticall

in women under

oin

abdominal h

terectomy. Hirsch found 30 studies involving 3752 patients, of whom 2165 had

been treated and 1587 were used as controls. Febrile morbidit

occurred in

48 (16%) of 2165 women who received antibiotics com

ared to 444 (28%) o

1587 women who did not receive antibiotics

(

0.57

;

0.51–0.65

;

0.01). Pelvic infection occurred in 57 (5%) of 1196 women who received

https://t.me/med1917

R.F. Lamont and S.V.Z. Ha

nti

iotics com

are

to 114 (10%) o

1144 women w

not receive anti-

iotics

(

0.48

;

0.35–0.

;

0.001

)

. T

e nature o

e a

omina

sterectom

proce

ure provi

a t

outcome cate

—woun

ion—

or ana

sis. In t

is cate

, 45 (3%) o

1434 women w

o receive

nti

iotics

eve

a woun

ection com

are

to 98 (8%) o

1194 women

ho did not receive antibiotics

(

0.38

;

0.27–0.54

;

0.01

)

nal Versus Abdom

nal H

sterectom

roun

e time o

e Hirsc

review [3], 2 stu

ies [4,5] re

orte

ost-

perative comp

ications o

ina

versus a

omina

sterectom

. S

apiro

t a

. [4]

oun

at a

er inci

ence o

ection at t

e operation site was

ssociate

wit

increase

uration o

e proce

ure,

anti

iotic prop

axis, younger age, an

an a

omina

approac

. Correcting

or t

ese associa

ions, t

ere was no pre

ictive va

ue o

owing: o

esity, preoperative

unctiona

anatomica

iagnosis, postoperative anatomica

pat

ogi-

iagnosis, estimate

oss, menopausa

status, or surgeon w

o per

orme

roce

ure. Dic

er et a

. [5] stu

1851 women

rom 9 institutions.

oun

at va

ina

sterectom

en compare

to a

omina

ster

ectomy was associated with signiﬁ

cantly fewer complications but more

ninten

surgica

proce

ures. Vagina

ysterectomy was associate

wit

ess

e mor

ity,

ess

ing requiring trans

usion, an

ess

ospita

iza-

ion an

conva

escence. Bearing in min

e resu

ts o

ese stu

ies [4,5] an

e review

y Hirsc

[3], in w

ere were more stu

ies (48 versus 30) an

ore patients (5524 versus 3752) in w

prop

actic anti

iotics were use

or vagina

ysterectomy compare

to a

omina

ysterectomy, it seems

at up to 1985, anti

iotics were use

pre

erentia

or vagina

ysterectom

ompare

to a

omina

ysterectomy, t

oug

ogic o

is c

oice is

ear. T

is is emp

asize

y t

e conc

usion o

Dic

er et a

. [5], w

o c

aime

at w

e vagina

ysterectomy wit

anti

iotics

etter outcome t

abd

omina

ysterectomy, t

erences were pro

y attri

uta

e to t

prevalence and efﬁ

cacy of antibiotic usage in vaginal hysterectomy.

acterial Vaginosis and Post-h

sterectom

Infect

ous Morb

wo studies [6,7], in neither of which antibiotic prophylaxis was used,

hli

hted the association between BV and post-h

sterectom

inal cuf

ellulitis. Soper et al. [6] found that 11 (34%) of 32 women with BV developed

ost-h

sterectom

inal cuff cellulitis compared to onl

11 (11%) of 102 of

women with normal ﬂ

ora (RR

3.2

;

1.5–6.7

;

0.005

)

. Larsson et al. [7]

ound that 7 (35%) of 20 women with BV developed post-h

sterectom

inal

https://t.me/med1917

1. Prevention of Infection Following G

necological Surger

cuff infection compared to 4 (8%) of 50 with normal ﬂ

ora

(

4.4;

–

;

0.01

)

f Ant

ibio

e important association o

BV an

BV-re

ate

anisms an

eve

opment o

post-

sterectom

ectious mor

, it is important t

e anti

iotics use

prop

hyl

actica

lly

are active a

ainst t

ose or

anisms, par-

ticularly anaerobes. In a metaanalysis, Mittendorf et al. [8] identiﬁ

ran

omize

contro

tria

s o

anti

iotic prop

axis t

at use

vigorous pro-

toco

s. T

per

orme

metaana

ses an

cumu

ative metaana

ses

or a

tria

s. Separate metaana

yses were per

orme

or ce

azo

in, metroni

azo

and tinidazole. Overall, 21% (373/1768) of

atients who did not receive anti-

biotic proph

laxis had serious infection after abdominal h

sterectom

. In

comparison, of women who received an

antibiotics, onl

9% (166/1836) had

erious

osto

erative infections

(

0.00001). Amon

those who received

cefazolin, metronidazole, or tinidazole, 11.4%

(

70/615;

0.00021

)

, 6.3%

17/269;

0.015

)

, an

(

5/101;

0.034), respective

serious post-

operative mor

. T

e metaana

ses

or in

ivi

stu

ies an

a cumu

ative

metaana

sis are s

own in Fi

ure 1.1. Mitten

et a

. conc

at ran

ize

contro

tria

s o

anti

iotic prop

hyl

axis in a

omina

sterectom

used controls who received no treatment are no longer justiﬁ

. Moreover

conc

, i

e resu

ts o

e various stu

ies

een poo

at an

earlier date, the ina

riateness of controls who received no treatment

would have been discovered in 1980 for cefazolin

in 1984 for metronidazole

in 1

or tini

azo

e Swe

Nationa

Stu

ection a

ter H

sterectom

(1996), w

took place before publication of the Mittendorf metaanal

sis, involved 1060

women

rom 42 centers,

et inc

236 women (22%) w

o were

iven

preoperative or postoperative anti

iotics [9]. Not surprisin

gly

, t

e postopera

tive in

ection rate was

, at 23%, 9.4% o

an in

ection t

at was

situate

eit

er in t

e woun

, in t

e va

ina

, or

eep in t

e pe

vis. T

irteen

percent had a urinar

tract infection (UTI), and 4% had infections distant from

e site. On

50% o

e woun

, cu

, an

eep-pe

vic in

ections were

etecte

ore

isc

rom t

ospita

. An increase

ris

postoperative in

ec-

tion was associate

wit

Wert

eims-Mei

sterectom

(21.4%; RR

3.0

;

0.03), intrao

erative

oss o

000 mL

(

15%; RR

;

0.001

)

, an

(

17%; RR

0.05). A

mittin

at t

e pu

ication o

Mitten

et a

. (1993) [8]

not

een

rawn to t

eir attention unti

ter

aration

eir manuscript, Henri

sson et a

. (1998) [10] reporte

at 500 mg o

metroni

azo

e a

ministere

intravenous

to 134 women imme

iate

ore

total abdominal hysterectomy resulted in a signiﬁ

cantly lower erythrocyte

imentation rate on

6 (50 mm/

r vs 56 mm/

0.05

)

, rate o

ection

9% vs 17%;

0.04), an

uration o

osto

erative

ita

ization (7.9 vs

8.8 da

0.02

)

https://t.me/med1917

R.F. Lamont and S.V.Z. Ha

Odds Ratio 95% CL Odds Ratio 95% CL

0.01

Study

Allen

Ohm

Mathews

Jennings

Holman

Roberts

Appelbaum

Grossman-cef

Grossman-pen

Adno

Polk

Itskomtz

Stage

Duff

Walker

Vincelelfe

Gall-cetep

Gall-cetarn

Hetnsell

Kauppla

Houang-sul

Houang-met

Gonen-cef-3

Gonan-cef-6

Crosthwade

Evaidson

Hakim-cef

Hakim-mez

Davey-mez

Davey-cephr

Munck

Overall

Favors Treatment Favors Treatment

z = –7.59 2P < 0.00021

Favors Control

1972

1975

1977

1978

1979

1980

1982

1983

1984

1985

1986

1988

1989

168

102

104

163

160

429

110

106

100

112

100

107

116

143

105

107

203

199

166

3604

168

261

320

422

502

549

653

816

976

1013

1442

1511

1621

1712

1800

1906

1945

1981

2081

2193

2293

2400

2516

2659

2726

2624

2929

3036

3239

3438

3604

Year

No.

Patients

0.1 1 10 100 0.01 0.1 1 10 100

ure 1.1. All antibiotic proph

laxis studies combined. Odds ratios for occurrence of serious infection after h

sterectom

, DerSimonian an

effects model. In the left-hand graph, point estimates and 95% confidence intervals are given for each individual stud

, with p

res

t the

On the right-hand side, the same data are presented as a cumulative metaanal

sis

https://t.me/med1917

1. Prevention of Infection Following G

necological Surger

revent

f Infect

n Ass

th Term

f Pregnanc

owin

an unpu

ot stu

in Swansea, Wa

es, in women pre

entin

for TOP, in which the rate of pelvic infection was hi

her than expected,

a lar

er, more formal stud

was performed. The stud

recruited 400 women

atten

or termination o

pre

nanc

. One

twe

ve women (28%)

BV, 95

(

24%

)

can

a, 3

(

0.75%

)

richomonas

(

0.25%

)

onorr

ea. O

32 women (8%) wit

ia, 63%

eve

ope

posta

orta

vic in

ection, requirin

7 to

e rea

mitte

to t

ospita

. As a resu

t, t

authors recommended that, since the estimated cost of hos

ital admission

due to chlam

dia was twice the estimated cost of screenin

for and treatin

chlam

dia, screenin

for chlam

dia was essential, and proph

lactic antibiotics

hould cover both chlam

dia and BV [11]

he incidence of

ostabortal se

sis (PAS) is estimated to be between 4%

and 12%. Those women with BV have a 3-fold increased risk of PAS com

ared

n wi

Lactobacillus

spp–dominated ﬂ

ora [12]. Prophylactic metro-

idazole reduces PAS b

66% [13,14]. In a randomized, double-blind, placebo

ontrolled trial of 231 women attendin

for TOP who were

iven either

00 m

of metronidazole or placebo for 10 da

s startin

the week preopera-

ive

, t

e inci

ence o

PAS was 3.8% in t

e metroni

azo

roup compare

ith 12.2% in the placebo

roup

(

0.05

)

[13]. The incidence of PAS can also

e reduced b

the administration of 2% clindam

cin va

inal cream preopera

tively in women with abnormal ﬂ

ora [15]. Penney et al. [16] found that pro-

laxis a

ainst PAS was as

ood as screenin

and treatment and more

cost

ect

n the summar

of recommendations, section 5.5 of the national evidence

ased clinical

uidelines for the care of women requestin

induced abortion,

vidence (level A) states that “abortion care should encompass a strate

for

inimizin

the risk of post abortion infectious morbidit

.” Level-B evidence

tates that “appropriate strate

ies include: antibiotic proph

laxis or screenin

or lower

enital tract or

anisms with treatment of positive cases.” An example

f metronidazole 1

per rectum at the time of TOP plus dox

cline 100 m

wice dail

for 7 da

s commencin

post-TOP is

iven

ite this and other recommendations, such as the Government Chief

Medical Ofﬁ

cer’s Expert Advisory Group [17] and the 31st Study Group for

he Ro

al Colle

e of Obstetricians and G

naecolo

ists (RCOG) on the Preven

ion of Pelvic Infection [18], for the prevention of pelvic infection followin

OP and uterine instrumentation there still appears to be lack of uniformit

n the United Kin

dom. Skinner et al. [19] sent an anon

mized questionnaire

necolo

ists in the North and South Thames re

ion of the United Kin

dom

equestin

information on case load, screenin

policies for infection, and the

se o

prop

hyl

actic anti

iotics

or women un

oin

TOP, insertion o

intra

terine contraceptive

evice,

aparoscop

, an

ometria

samp

/or

ysteroscopy. Respon

ents were as

out screening proce

ures

or genita

ections, anti

iotic regimes use

, an

vice given to women on re

erra

https://t.me/med1917

R.F. Lamont and S.V.Z. Ha

genitourinary medicine clinics. Only 55% fulﬁ

lled RCOG guidelines for the

revention o

ection prior to TOP. On

40%

owe

ines

or ot

er uterine instrumentation

roce

ures, an

en anti

iotics were use

y 42% a

ministere

anti

iotics t

at were active against

amy

rac

omati

BV. T

e aut

ors conc

at t

ere were mar

inconsis

encies an

uni

ormit

at anti

iotic re

imes were

requent

equate or inappropriate [19]

nfections Postoperative Hysteroscop

e accepting t

e recommen

ations an

gui

ines

rom nationa

ies, c

inica

ectiveness groups, pro

essiona

ies, RCOG stu

y groups,

expert a

visory groups concerning t

e use o

anti

iotic prop

axis to

revent in

ection w

en uterine instrumentation is invo

, a recent report o

952 operative

ysteroscopies

rom Marsei

e, France, recor

a remar

ow inci

ence o

postoperative in

ection

espite t

act t

at no anti

iotic

rop

axis was use

. Fo

owing 782 resections o

eiomyomata, 422

o metria

ypectomies, an

90 uterine septa resections, toget

er wit

623

ometrectomies an

199

yses o

intrauterine synec

iae, t

e inci

ence o

ometritis an

UTI was extreme

ow at 18 (0.9%) o

1952 an

12 (0.6%)

1952, respective

y [20]

onclus

n Jul

3, 1909, at the a

e of 47, Herman Pfannenstiel (1862–1909), the

erlin

necolo

ist who

ave his name to the low transverse incision so com-

onl

used in obstetrics and

necolo

, died of septicemia 1 week after a

needle-stick injury to his left middle ﬁ

nger, sustained while operating on a

atient with a tubo-ovarian abscess. With the introduction of antibiotics,

ost

perative infections are no lon

er the dan

er the

were for patients or their

eons but are still common, potentiall

life threatenin

, and a drain on

ealth care. The followin

bullet points represent the evidence available for

he prevention of infection followin

necolo

ical sur

Prophylactic antibiotics signiﬁ

cantly reduce infectious morbidity

ollowin

sterectom

and termination of pre

nanc

inal h

sterectom

is associated with less infectious morbidit

than total abdominal hysterectomy, but all hysterectomies should

have antibiotic proph

laxis.

Consensus guidelines also recommend antibiotic prophylaxis for

other

rocedures that involve uterine instrumentation.

Proph

lactic antibiotics for TOP are as

ood as screenin

and treat

ment and probabl

more cost-effective. The possible exception to

this rule is amon

women under the a

e of 20

ears in whom screen-

https://t.me/med1917

1. Prevention of Infection Following G

necological Surger

or sexua

lly

transmitte

ection suc

ia trac

oma-

onococcus, an

richomonas

is more

to resu

t in positive

tures, wit

e a

vanta

e o

enito-urinar

icine

GUM) re

erra

contact tracin

Proph

lactic antibiotics for TOP should cover both chlam

dia and

V (e.

., dox

cline 200 m

dail

plus metronidazole 1

per rectum

wice

or 400 m

ree times

, or er

rom

cin 500 m

our

imes dail

and clindam

cin 300 m

twice dail

)

Antibiotic proph

laxis for h

sterectom

should be broad spectrum

s well as antianaerobe to cover wound infection and

TI as well as

itis an

eep-pe

vic in

ection (e.

., metroni

azo

e 1

per

ectum before sur

plus 750 m

cefuroxime IV with induction

f anesthesia or 1.2

of co-amoxiclav with the induction o

nest

esia

With the strength of evidence available to show the beneﬁ

iotic proph

laxis for h

sterectom

and TOP, particularl

with

espect to coverin

both chlam

dia and BV, to

ether with man

ther sources of national clinical

uidelines and recommendations

rom

overnment and national expert advisor

roups, failure

ow t

e a

vice wou

eave c

inicians o

en to me

ica

iti

ation

eferen

1. Tamussino K. Posto

erative infection.

lin Obstet Gynecol. 2002

;

45:5

2–573.

2. Boyle DCM, Adinkra PE, Lamont RF. Bacterial vaginosis. In: Studd JWW, ed. Prog

ress in Obstetrics and Gynaecology

Vol 15. London: Churchill Livingston; 2002:

–21

3. Hirsch HA. Proph

lactic antibiotics in obstetrics and

naecolo

Obste

neco

. 1985;78(supp

6B):170–176

4. S

apiro M, Munoz A, Ta

er IB, Sc

oen

aum SC, Po

BF. Ris

actors

or in

ection

at t

e operative site a

ter a

omina

or va

ina

sterectom

J Me

1982

;

307:1661–1666

5. Dic

er RC, Greenspan JR, Strauss LT, et a

. Comp

ications o

omina

vagina

hysterectomy among women of reproductive age in the United States. The collab

rative review of sterilization. Am J Obstet Gynecol

1982;1

44:

–

6. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are

risk factors for cuff cellulitis after abdominal hysterectomy.

m J Obstet Gynecol

1990;163:1016–1023

7. Larsson P-G, P

atz-C

ristensen J-J, Forsum J, På

son C. C

ue ce

s in pre

ictin

ections a

ter a

omina

sterectom

. O

stet G

neco

1991

;77:45

–45

8. Mitten

R, Aronson MP, Berry RE, et a

. Avoi

ing serious in

ections associate

omina

ysterectomy: a metaana

ysis o

anti

iotic prop

axis. Am J O

stet

neco

1993

;

9:1119–1124.

https://t.me/med1917

0 R.F. Lamont and S.V.Z. Ha

nes

9. Peresson E, Ber

strom M, Larsson P-G, et al. Infections after h

sterectom

Acta

stet G

neco

Scan

. 1996;75:757–761.

10. Henri

sson L, Co

-Sa

tin A-S, Fric

G, et a

. Metroni

azo

e prop

hyl

axis to

revent in

ections a

ter tota

omina

ysterectomy.

cta O

stet G

neco

Scan

1998

;

77:11

–119.

11. B

AL, T

omas PD, Ware

am K, Emery SJ. Hea

gains

rom screening

infection of the lower genital tract in women attending for termination of pregnancy.

Lancet.

993

;

342:20

–210.

12. Larsson P-G, Ber

han B, Forsum U, Platz-Christensen J-J, Påhlson C. M

obiluncus

and clue cells as predictors of PID after ﬁ

rim

este

abo

Acta Obstet Gynecol

cand

1989;68:217–220

3. Larsson P-G, Platz-Christensen J-J, Hennin

T, Forsum U, Påhlson C. Incidence of

pelvic inﬂ

ammatory disease after ﬁ

rst trimester legal abortion in women with bacte-

ria

inosis a

ter treatment wit

metroni

azo

e: a

ran

omise

stu

Am J O

stet G

neco

1992

;

:100–103

4. Crow

ey T, Low N, Turner A, Harvey I, Bi

goo

K, Horner P. Anti

iotic prop

axis

o prevent post-a

orta

upper genita

tract in

ection in women wit

acteria

vagi-

sed

r J Obstet Gynaecol. 2001

;

108:39

–402.

5. Larsson P-G, Platz-Christensen J-J, Dalaker K. Treatment with 2% clindamycin

vaginal cream prior to ﬁ

rst trimester surgical abortion to reduce signs of postopera-

ive infection: a prospective, double blinded, placebo controlled, multicentre stud

Acta O

stet G

neco

Scan

. 2000;79:390–396.

6. Penne

GC, T

omson M, Norman J, et a

. A ran

omize

comparison o

strate

ies

or re

ucing in

ective comp

ications o

uce

ortion.

r J O

stet G

naeco

1998

;

105:599–

04.

7. CMO’s Expert A

visory Group.

ia trac

omatis

Lon

on: Department o

ealth

;

1998

8. Tem

leton A, ed.

ecommendations arising from the 31st study group: the preven

ion o

elvic in

ection

London: RCOG Press; 1996:267–270.

9. Skinner CJ, Estcourt CS, Grant L, Forster GE. Prevention of

elvic infection: room

or improvement.

STD AIDS

1999;10:351.

20. A

ostini A, Cravello L, Sho

ai R, Ronda I, Ro

er V, Blanc B. Postoperative infection

sur

ica

steroscop

erti

teri

. 2002;77:766–768.

https://t.me/med1917

2. Com

lications in

necological Oncolog

Robin A.F. Crawford

n ten years as a consultant, I have never taken a woman back to theater after my

surgery

—Anon

mous specialist, eastern re

ion, 2002

is quote provi

es a very goo

intro

uction to t

is c

apter. Comp

ications

occur in a

orms o

gyneco

ogica

surgery. T

ey can

e re

uce

y a variet

of strategies. The view expressed by the consultant quoted above may reﬂ

a num

er o

points. First, t

e consu

tant’s surgica

wor

or practice ma

e too sma

. Un

ess comp

ications occur

requent

y, t

e practitioner wit

practice wi

not see many pro

ems wit

in an assessa

e time

rame.

ere

ore, t

ere wi

e a

insig

t wit

regar

to t

ese pro

ems or even

a se

ective memory,

ing t

e practitioner to

ieve t

is or

er surgeries

ave

ew or no comp

ications. T

is tren

een compoun

in t

e Nationa

Hea

Service (NHS)

y poor

ata co

ection an

no agreement regar

ing t

minimum

ata set re

ating to comp

ications. Au

it o

outcomes an

comp

ica-

tions is sporadic and usually covers only a short time period. This deﬁ

cit a

s to comp

acency wit

respect to comp

ications.

n gyneco

ogica

onco

ogy surgery, t

ere are some

ata re

ating to comp

cations. Increasing

y, we are

ing wit

a centra

ize

service

owing t

intro

uction o

e Improving Outcomes Gui

ance in Eng

es [1].

is centra

ization an

e intro

uction o

man

atory minimum

ata-set co

ection wi

to more in

ormation a

out comp

ications an

uce

e num

er o

practitioners w

o su

scri

e to t

e opinion voice

in t

is c

ter

’

s opening quote.

adical Cancer Surgery

The aim of radical cancer surgery is in the ﬁ

rst

nstance curat

ve. In ovar

cancer, surgery is

iagnostic (provi

ing

isto

ogica

materia

), nee

staging, and also therapeutic [2], regardless of the ﬁ

nal stage. In endometrial

cancer, t

e surgery is t

e cornerstone o

treatment even wit

vance

isease,

provi

ing in

ormation re

ating to stage as we

[3]. In cervica

cancer, surger

is reserved for curative intent in patients with early disease. In patients with

recurrent cervical disease, sur

be curative with exenteration [4] but

is more often palliative to control s

mptoms

https://t.me/med1917

2 R

ompl

cat

ons of Rad

cal Surger

nesthetic and Perio

erative Com

lications

e outcome o

surgery

epen

s in part on t

e patient’s

ﬁ

tness (see Figure

.1). T

e patients we treat w

ave gyneco

ogica

cancer usua

y comprise an

old

er popu

ation t

an patients wit

er gyneco

ogica

con

itions. Consi

er-

abl

e comor

ity is present in t

e gyneco

ogica

cancer popu

ation; t

omor

ity in itse

s to a

er rate o

comp

ication. In comparing

utcomes, inc

ing

ospita

stay, t

ese comor

ities s

e ta

en into

ccount. T

is may

e a

resse

using an eva

uation too

suc

as t

e “a

omor

ity eva

uation-27” s

eet [5], w

may

e use

or t

e minimum

ancer

ata set.

erioperative

eat

(wit

in 24

ours) was 8.8. per 10,000 anest

esia

ministrations, wit

85% o

eat

s re

ate

to t

e patient’s comor

ity.

us, se

ection o

e appropriate operation

or eac

patient is important. In

e group o

patients w

as a resu

t o

anest

etic-re

ate

pro

ems, 25%

ere ina

equate

y prepare

or surgery [6].

ppropriate

iaison wit

consu

tant anest

etists an

suita

e preoperative

reparation o

patients wit

gyneco

ogica

cancer

etter outcomes. T

rimary

ing surgery require

or a

vance

ovarian cancer or t

e man

gement o

e patient

or interva

ing surgery is not compara

e to

outine

enign gyneco

ogica

surgery, an

ere

ore t

ere is an intraoperative

equirement

or epi

ura

usage, centra

venous an

arteria

monitoring, an

ostoperative

epen

ency or intensive-care support

uction re

ating to anest

esia can

e ac

ieve

y t

owing

ract

ces:

e use o

an appropriate

y s

anest

etist provi

ing an apt

preoperat

ve assessment

e use o

intraoperative regiona

anest

esia in a

ition to genera

anest

esia, w

s to re

uce

amount o

centra

ation,

Anesthetic Infection Thrombosis

Complications of

Radical Surgery

Psychological

Problems

Organ

Damage

Hemorrhage

ure 2.1. Complications of radical surger

https://t.me/med1917

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