Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery
Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery
Background: Group preoperative education is becoming standard care for patients preparing for surgery, alongside optimisation of exercise, diet, and wellbeing. Although patient education is essential, the effectiveness of group education programmes or ‘surgery schools’ as a means of delivery is unclear. This review examines whether attending group preoperative education improves patient outcomes. Methods: We systematically reviewed studies of group perioperative education before major elective surgery. Observational or intervention studies with a baseline group or control arm were included. All outcomes reported were collected and, where possible, effect estimates were summarised using random effects meta-analysis. Results: Twenty-seven studies reported on 48 different outcomes after group education. Overall, there was a 0.7 (95% confidence interval 0.27–1.13) day reduction in mean length of stay. The odds ratio for postoperative complications after abdominal surgery was 0.56 (95% confidence interval 0.36–0.85; nine studies). Patient-centred outcomes were grouped into themes. Most studies reported a benefit from group education, but only postoperative physical impairment, pain, knowledge, activation, preoperative anxiety, and some elements of quality of life were statistically significant. Conclusion: This review presents a summary of published evidence available for group preoperative education. While these data lend support for such programmes, there is a need for adequately powered prospective studies to evaluate the effectiveness of preoperative education on clinical outcomes and to evaluate whether behaviour change is sustained. Furthermore, the content, timing and mode of delivery, and evaluation measures of preoperative education require standardisation. Systematic review protocol: PROSPERO (166297).
perioperative medicine, prehabilitation, preoperative education, surgery school, systematic review
Fecher-Jones, Imogen
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Grimmett, Chloe
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Ainsworth, Ben
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Wensley, Frances
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Rossiter, Laura
03e84799-86ea-41ac-96d9-d424767dcac0
Grocott, Michael P.W.
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Levett, Denny Z.H.
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June 2024
Fecher-Jones, Imogen
f9585e80-16ba-4ab8-9876-9f3742bfa103
Grimmett, Chloe
7f27e85b-2850-481d-a7dd-2835e1a925cd
Ainsworth, Ben
b02d78c3-aa8b-462d-a534-31f1bf164f81
Wensley, Frances
94fcb439-3af1-4e66-9e73-fe93aea18a3d
Rossiter, Laura
03e84799-86ea-41ac-96d9-d424767dcac0
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Levett, Denny Z.H.
988e5b05-9a3e-43b1-9629-61faef0c40f0
Fecher-Jones, Imogen, Grimmett, Chloe, Ainsworth, Ben, Wensley, Frances, Rossiter, Laura, Grocott, Michael P.W. and Levett, Denny Z.H.
(2024)
Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery.
BJA Open, 10, [100286].
(doi:10.1016/j.bjao.2024.100286).
Abstract
Background: Group preoperative education is becoming standard care for patients preparing for surgery, alongside optimisation of exercise, diet, and wellbeing. Although patient education is essential, the effectiveness of group education programmes or ‘surgery schools’ as a means of delivery is unclear. This review examines whether attending group preoperative education improves patient outcomes. Methods: We systematically reviewed studies of group perioperative education before major elective surgery. Observational or intervention studies with a baseline group or control arm were included. All outcomes reported were collected and, where possible, effect estimates were summarised using random effects meta-analysis. Results: Twenty-seven studies reported on 48 different outcomes after group education. Overall, there was a 0.7 (95% confidence interval 0.27–1.13) day reduction in mean length of stay. The odds ratio for postoperative complications after abdominal surgery was 0.56 (95% confidence interval 0.36–0.85; nine studies). Patient-centred outcomes were grouped into themes. Most studies reported a benefit from group education, but only postoperative physical impairment, pain, knowledge, activation, preoperative anxiety, and some elements of quality of life were statistically significant. Conclusion: This review presents a summary of published evidence available for group preoperative education. While these data lend support for such programmes, there is a need for adequately powered prospective studies to evaluate the effectiveness of preoperative education on clinical outcomes and to evaluate whether behaviour change is sustained. Furthermore, the content, timing and mode of delivery, and evaluation measures of preoperative education require standardisation. Systematic review protocol: PROSPERO (166297).
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Accepted/In Press date: 14 April 2024
e-pub ahead of print date: 22 May 2024
Published date: June 2024
Additional Information:
Crown Copyright © 2024 Published by Elsevier Ltd on behalf of British Journal of Anaesthesia.
Keywords:
perioperative medicine, prehabilitation, preoperative education, surgery school, systematic review
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Local EPrints ID: 490625
URI: http://eprints.soton.ac.uk/id/eprint/490625
ISSN: 2772-6096
PURE UUID: eaf284b9-3454-4924-827f-66b459fcdbf1
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Date deposited: 31 May 2024 16:46
Last modified: 12 Jun 2024 01:45
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Author:
Imogen Fecher-Jones
Author:
Ben Ainsworth
Author:
Frances Wensley
Author:
Laura Rossiter
Author:
Denny Z.H. Levett
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