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Lindsay Curtis, MD
CHAPTER 34
Preoperative Evaluation
and Preparation of
Gynecologic Surgery
❍ What is the purpose of the preoperative counseling of the patient?
Provide informed consent, allows the patient to have questions answered, to work through emotions, and build trust.
❍ What material facts must a physician disclose in order to obtain effective informed consent?
Informed consent must include the patient’s diagnosis, proposed treatment, risks and benefits of the treatment,
alternatives, and risks of refusal.
❍ A physician who fails to obtain informed consent prior to surgery may be accused of what legal charges?
Battery actions and negligent nondisclosure.
❍ What four elements must be shown for a physician to be liable for negligent nondisclosure?
Duty, breach of duty, injury, and causal relationship.
❍ What pertinent family history may play a role in the preoperative evaluation of a patient?
A family history of bleeding disorders or malignant hyperthermia, which can be inherited as an autosomal
dominant disorder, can be important.
❍ What laboratory evaluation should be performed on a routine preoperative workup?
A complete blood count with hemoglobin level and platelet count is essential. Chemistries and/or coagulation
studies are rarely helpful unless the patient has significant medical history.
❍ What is the anesthesiology classification of surgical risk?
The Dripps-American Society of Anesthesiologists’ Classification of surgical risk ranging from Class 1 (normal
healthy patient) to Class 5 (moribund patient not expected to survive 24 hours with or without operation).
❍ The majority of gynecology procedures, including hysterectomy, dilation and curettage, and cesarean
delivery, fall under what wound classification?
Class II/clean-contaminated. This category includes any procedure that breeches the alimentary, genital, or urinary
tracts under controlled conditions without unusual contamination.