The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis

Abstract

Background Cardiac surgeries pose as an emotional experience for patients. Preoperative education is known to positively alter people’s perceptions, emotions, and mitigate surgical distress. However, this intervention’s effectiveness in improving perioperative outcomes among patients undergoing cardiac surgery lacked rigorous statistical synthesis and remains inconclusive. Aims The aim was to synthesize the effectiveness of preoperative education on improving perioperative outcomes [anxiety, depression, knowledge, pain intensity, pain interference with daily activities, postoperative complications, length of hospitalization, length of intensive care unit (ICU) stay, satisfaction with the intervention and care, and health-related quality of life] among patients undergoing cardiac surgery. Methods This systematic review and meta-analysis conducted a comprehensive search of nine electronic databases (PubMed, EMBASE, Scopus, MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, PsycINFO, and ERIC) and grey literature for randomized controlled trials examining the preoperative educational interventional effects on patients undergoing cardiac surgery from inception to 31 December 2020. The studies’ quality was evaluated using Cochrane Risk-of-Bias Tool 1 (RoB1). Meta-analyses via RevMan 5.4 software synthesized interventional effects. Results Twenty-two trials involving 3167 participants were included. Preoperative education had large significant effects on reducing post-intervention preoperative anxiety (P = 0.02), length of ICU stay (P = 0.02), and improving knowledge (P < 0.00001), but small significant effect sizes on lowering postoperative anxiety (P < 0.0001), depression (P = 0.03), and enhancing satisfaction (P = 0.04). Conclusions This review indicates the feasibility of preoperative education in clinical use to enhance health outcomes of patients undergoing cardiac surgery. Future studies need to explore knowledge outcomes in-depth and more innovative technologies in preoperative education delivery.

A rapid review of the effectiveness of innovations to support patients on elective surgical waiting lists

“…Ng et al (2021) found that preoperative education had large significant effects on reducing post intervention preoperative anxiety, length of ICU stay, and improving knowledge in adult patients undergoing cardiac surgery. Small significant effects were also found for reducing postoperative anxiety, depression, and enhancing satisfaction.…”

“…Three systematic reviews (Burgess et al, 2019, Ng et al, 2021, Van der Gucht et al, 2021) provided evidence on the effectiveness of preoperative educational interventions on improving outcomes of patients awaiting elective surgery. One of the reviews targeted patients awaiting orthopaedic surgery (spinal surgery), another on cardiac surgery, and the third review did not have any specific surgical focus (elective surgery).…”

“…The review authors believe that from the limited evidence, it is not possible to conclusively recommend the delivery of preoperative education as a standalone intervention before elective spine surgery. Ng et al (2021) found that preoperative education had large significant effects on reducing post intervention preoperative anxiety, length of ICU stay, and improving knowledge in adult patients undergoing cardiac surgery. Small significant effects were also found for reducing postoperative anxiety, depression, and enhancing satisfaction.…”

Psychometric Properties of the Persian Version Fear of Hospitalization Scale in Patients Undergoing Emergency Surgery

“…When hospitalization and surgery are combined, patients' concerns and anxieties increase (Chen, Soens, & Kovacheva, 2022;Ng, Wang, Shen, Toh, & He, 2021) Surgery is stressful and may have an adverse effect on a person's physical and mental health (Vaughn, Wichowski, & Bosworth, 2007;Yang et al, 2022). Emergency surgery candidates frequently display tension and anxiety.…”

“…Emergency hospitalization is associated with fear and anxiety, but invasive and surgical interventions increase this anxiety and fear (Chen et al, 2022;Ng et al, 2021) . As a result, patients undergoing emergency surgery were chosen for this study.…”