Preoperative education (preoperative teaching)

Preoperative education refers to any educational intervention provided before surgery that aims to improve people’s knowledge, health behaviors, and health outcomes. The content of the education varies depending on the type of surgery involved, but the topics are generally similar. There is often discussion of presurgical procedures, the details of the surgery, postoperative care, potential stressful scenarios related to the surgery, potential surgical and non-surgical complications, postoperative pain management, and movements to avoid post-surgery. The education is often given by nurses, physician assistants, psychologists, or the physicians themselves. The material is often delivered in one-on-one sessions, group sessions, or through videos or booklets. Some medical centers have even provided webinars for their patients’ preoperative education. The results coming from this type of education are usually positive but also depend upon the patient and their condition. It is also important to note that each patient’s preoperative education should be tailored to them personally.

Background

One of the primary functions of preoperative education is the effect it can have on patient expectations regarding long-term outcomes after surgery, the stay in the hospital, and the transfer from the hospital to post-acute care. Research has shown that patients who receive preoperative education have improved patient outcomes, and many alter their behavior or ideas in a positive way. Patients often undergo lifestyle changes that help deal with chronic illnesses such as cardiovascular disease, diabetes, and arthritis.

Patient education can be enhanced in many ways before and after a procedure. Approaches to this include discussing the patient’s medical history, implementing recovery programs, and holding preoperative meetings. Those conducting the education programs should be keen to the unique learning needs of individuals, and tailor their teaching to them. Education programs should also make certain that the patient is comfortable with the discussion, including ensuring that the patient does not have an increased anxiety level about the procedure. In addition, teaching should go beyond procedure descriptions and focus on the sensations a patient will experience. For example, patients should be told medication may result in light-headedness and drowsiness, instead of just telling them the medication will relax them. Patients should also be educated on the difference between acute and chronic pain so they can adequately advise their medical team. Preoperative education can have many implications, from a prepared program with specified content, approaches, and measurable outcomes, to an informal method that considers the patient’s perceptions, beliefs, learning styles, and organizational constraints.

With proper education and awareness of expectations and goals during a surgical procedure, patients often see an improved medical outcome. If compared to a patient who has emergency surgery versus a patient that has a scheduled procedure, the one with the scheduled procedure is educated on expectations and goals during the pre-admission phase and may have also received preoperative education in the doctor’s office prior to the surgery day. A patient who has emergency surgery does not get the benefit of receiving information and interacting with staff prior to the surgery.

Preoperative education is not a one-way dialogue. As a patient, one should ask as many questions as possible prior to surgery. A common opening question is why the surgeon recommended a specific surgery, and if there are different methods of doing the operation. Alternatives to the type of procedure being recommended should be discussed, such as whether lifestyle changes or other nonsurgical treatments could be beneficial. The healthcare provider should be asked the benefits of the surgery and how long they will last. Other questions include length of hospital stay, needed supplies or medications after discharge, side effects, complications, behaviors to avoid in supporting recovery, and when normal activity may be resumed. The answers to these questions can help in preparation ahead of time. If it is known that help from a caregiver will be necessary, for example, a patient may arrange for it before surgery. It is also important to learn how to prevent, recognize, and respond to possible complications. Inquiring about the healthcare provider’s experience doing the scheduled procedure may help, as will asking about where the surgery will be performed.

Overview

Gallup research has shown that the benefit of preoperative education has significant positive effects on surgery outcomes. The results included overall patient satisfaction, reduced problem incidence, and improved quality of life. Preoperative teaching also can benefit the bottom line for healthcare providers—fewer problems could reduce costly readmissions, revision surgeries, or malpractice lawsuits.

While some doctors rely on nurses or physician assistants to do the bulk of preoperative education, Dr. Ari Youderian, an orthopedic surgeon, does part of it himself. His patients begin with an office visit in which they discuss the condition, examine images, and review the timetable from preoperative to full recovery six to twelve months later. Youderian recommends that, in discussing complex surgeries, doctors should keep the discussion as simple as possible, provide an open dialogue with the patient, and use visual aids. Then the patient is scheduled for a visit led by the physician assistant. In this meeting, the process, day-of-surgery details, wound care, and paperwork is reviewed. They also discuss postoperative exercises. Inpatient surgical patients are urged to attend specific classes provided by the hospital. Youderian helped develop the program and about 90 percent of patients attend. All outpatient surgical patients are set up with a nurse navigator who directs their pre- and postoperative care. The nurse navigator follows up by phone after the surgery.

Nutrition is also a critical part of preoperative education. Those who are well-nourished before procedures see an easier recovery, shorter hospital stays, and reduced complications. According to a Johns Hopkins study, up to 50 percent of patients are malnourished when admitted to the hospital, but only 20 percent receive a nutritional consultation. Hydration before surgery also is necessary. Studies show that when patients are well hydrated, they report less pain and nausea after surgery. While the norm is fasting for twelve-hour before surgery, the American Society of Anesthesiologists has said that patients can consume clear liquids up to two hours before surgery with no increased risk of complications.

One aspect of preoperative education is getting the patient ready to manage postoperative pain and decrease the number of opioids used. Opioid overdose is a continual problem in the United States, with 74,700/2 deaths reported by the National Centers for Disease Control in 2023. Because opioids are given predominately to manage pain, those unfamiliar with the drug may not understand the risk involved. With many opioids prescribed for an operation going unused, it is essential that patients are also educated in the proper disposal of opioids to prevent misuse and abuse not just by the patient, but by others as well.

Research has shown that patients who receive preoperative teaching were more likely to feel prepared to manage their postoperative pain than those who did not receive the education. The greatest rate of preparedness for pain management was among patients who received both pre- and postoperative education. Patients who felt prepared to manage their pain typically used fewer opioid pills postoperatively. For those who received preoperative education, preparedness was 20 percent greater than among patients who did not receive the education. Patients who reported both pre- and postoperative education reported the greatest rate of preparedness, which suggests that reinforcement of the education postoperatively can improve pain management.

For preoperative education to be effective, leaders in healthcare should emphasize proactive communication. When there is more communication, patients tend to be less anxious before procedures. A system of accountability should also be instituted to ensure healthcare staff is prepared to talk to patients. A checklist can also be beneficial for when, how, and what to teach patients, ensuring critical understanding. Healthcare providers should also personalize communications to meet each patient’s needs. Doctors and nurses may use focus groups with former patients to determine whether certain messages are received clearly and accurately.

Just as preoperative education is important to the patient’s wellbeing, postoperative teaching is also critical. Many times, it involves reviewing ideas gone over during the preoperative phase. As part of postoperative care, the provider will teach patients about the potential side effects and complications of the procedure. Patients should be reviewed for preparedness for discharge. Factors such as the presentation, timing, and frequency of discharge education are key in the delivery of information. The message should be tailored to the patient’s learning needs and use multiple media methods to conduct a successful discharge.

Bibliography

Ellrich, Mike, and Daniela Yu. “For Patients, Pre-Surgery Education is Lacking.” Gallup, 21 May 2015. news.gallup.com/businessjournal/183365/patients-pre-surgery-education-lacking.aspx. Accessed 9 Feb. 2025.

Grossweiler, Heidi. “Preoperative Education: How Effective Teaching Impacts Knowledge with the Surgical Patient.” Gardner-Webb University Digital Commons, 2012. digitalcommons.gardner-webb.edu/cgi/viewcontent.cgi?httpsredir=1&article=1119&context=nursing‗etd. Accessed 9 Feb. 2025.

“Questions to Ask Before Surgery,” John Hopkins Medicine. www.hopkinsmedicine.org/health/treatment-tests-and-therapies/questions-to-ask-before-surgery. Accessed 9 Feb. 2025.

Tadesse, Beza et al. “Preoperative Patient Education Practices and Predictors Among Nurses Working in East Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022.” Journal of Multidisciplinary Healthcare, vol. 16, 237-47. 25 Jan. 2023, doi:10.2147/JMDH.S398663. Accessed 9 Feb. 2025.

Vera, Matt. “Preoperative Phase.” Nurselabs, 23 Jan. 2014. nurseslabs.com/preoperative-phase/. Accessed 9 Feb. 2025.

Webb, Denise. “Optimizing Nutrition Before Surgery.” Today’s Dietician, January 2015. www.todaysdietitian.com/newarchives/011315p10.shtml. Accessed 9 Feb. 2025.