Levantamento do manejo pré-operatório em ginecologia e obstetrícia baseado em evidências: revisão sistemática

Abstract

Objective: This review aimed to evaluate the classification, management, and prophylactic measures of complications arising from diabetes mellitus, systemic arterial hypertension, anemia, and venous thromboembolism in the preoperative period of gynecological surgeries, aiming at reducing perioperative morbidity and mortality and identifying gaps in practices, suggesting improvements in care protocols. Methods: This is an integrative literature review, through research in online databases, PubMed, and the Virtual Health Library (VHL). A total of 157 publications related to the aforementioned issues were identified in the initial search, of which, after the application of filters and exclusion criteria, 23 were selected to be part of the work. Results: Studies indicate that high blood glucose levels in the pre- and postoperative period increase the risk of surgical complications in patients with DM or undiagnosed hyperglycemia. Elevated HbA1c (≥7%) is associated with higher mortality and recurrence of cervical cancer. In the postoperative period, blood glucose levels above 180 mg/dL are also associated with more complications. Studies highlight the efficacy of medications such as nifedipine and methyldopa in controlling blood pressure. Alternatives such as transcutaneous electrical stimulation (TEAS) show additional efficacy in reducing preoperative blood pressure in patients with gynecological tumors. Preoperative anemia increases the risk of complications and the need for transfusions in gynecological surgeries. Intravenous iron supplementation is effective for rapid correction of hemoglobin before surgery. Thromboprophylaxis is essential in gynecological surgeries, especially in patients with cancer. Pharmacological agents such as heparin, apixaban, and direct oral anticoagulants (DOACs) demonstrate efficacy, with apixaban presenting better cost-effectiveness and lower risk of VTE. Sequential compression devices complement pharmacological prophylaxis. Long-term prophylaxis is recommended for high-risk patients, while in minimally invasive procedures, the approach may be more selective. Conclusion: These findings reinforce the importance of individualized approaches to glycemic control, hypertension, anemia, and VTE prevention in the gynecological preoperative period. Adequate management of these conditions is essential to reduce complications and optimize clinical outcomes.