Effect of a preoperative evidence-based care education on postoperative recovery of cardiac surgery patients: A quasi-experimental study

INTRODUCTION

Preoperative nursing care affects many factors such as reducing the length of hospital stay of the patients in the perioperative period, the rate of postoperative complications, the duration of the operation, decrease of postoperative pain level and early mobilization.

AIMS

We aimed to determine the effect of preoperative evidence-based care education that given to cardiac surgery clinical nurses on the postoperative recovery of patients.

METHODS

The research was planned as quasi-experimental. Eighty-six patients who underwent cardiovascular surgery were divided into control and intervention groups. First, the ongoing preoperative care practices and patient recovery outcomes of the clinic were recorded for the control group data. Second, education was provided for the clinical nurses about the preoperative evidence-based care list, and a pilot application was implemented. Finally, the evidence-based care list was applied by the nurses to the intervention group, and its effects on patient outcomes were evaluated. The data were collected using the preoperative evidence-based care list, descriptive information form, intraoperative information form and postoperative patient evaluation form.

RESULTS

The evidence-based care list was applied to the patients in the intervention group, with 100% adherence by the nurses. All pain level measurements in the intervention group were significantly lower in all measurements (p = .00). The body temperature measurements (two measurements) of the intervention group were higher (p = .00). The postoperative hospital stays of the control group and the intervention group were 11.21 ± 8.41 and 9.50 ± 3.61 days.

CONCLUSION

The presented preoperative evidence-based care list can be used safely in nursing practices for patients. It provides effective normothermia, reduces the level of pain, shortens the hospital stay and reduces the number of postoperative complications.

RELEVANCE TO CLINICAL PRACTICE

By applying a preoperative evidence-based care to patients undergoing cardiac surgery, pain levels, hospital stays and the number of complications decrease, and it is possible to maintain normothermia. An evidence-based care can be used to ensure rapid postoperative recovery for patients undergoing cardiac surgery.

The Effect of Combination Prayer Therapy and Education on Pre-operative Coronary Artery Bypass Graft Anxiety

Background: Anxiety is a problem that most often occurs in the pre-operative coronary artery bypass graft surgery stage. The combination of prayer therapy with education is expected to be able to overcome anxiety. The combination of prayer and education therapy have been researched as a potential holistic intervention for reducing anxiety in coronary artery bypass graft surgery. Purpose: This study compares the effect of combination therapy with the golden standard of therapy in hospitals. Methods: A true-experimental design was used. Fifty participants were randomly assigned to two groups. Data were collected using a State-Trait Anxiety Inventory questionnaire from Spielberger. Findings: Most respondents were elderly, male, high school graduates in the treatment group, and bachelor graduates in the control group. Prayer therapy and education have an effect of 63.8% on reducing anxiety. An increase of 1 constant in the provision of prayer therapy and education can reduce anxiety by 0.772. Conclusions: The combination of prayer therapy and education becomes the holistic nursing modality that can reduce anxiety in pre-operative coronary artery bypass graft patients.

Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

BACKGROUND

The emergency department plays a crucial role in providing acute care to patients. Nursing interventions in this setting are essential for improving the continuity of care, enhancing patients' self-care abilities, and reducing psychological symp-toms.

AIM

To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department.

METHODS

A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023. The patients were divided into two groups: The control group (conventional nursing intervention) and the observation group (conventional nursing intervention + emergency department nursing intervention). The two groups were compared regarding continuity of care, self-care ability, psychological symptoms, and satisfaction with care.

RESULTS

The emergency department nursing interventions significantly improved the continuity of care, enhanced patients' self-care abilities, and reduced psychological symptoms such as anxiety and depression.

CONCLUSION

Nursing interventions in the emergency department positively impact continuity of care, self-care, and psychological symptoms. However, it is important to acknowledge the limitations of this study, including the small number of studies, variable methodological quality, and the heterogeneity of the study population. Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department. Additionally, efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

The Effect of Visits by Operating Room Nurses Before Cardiac Surgery on Anxiety and Pain Management

PURPOSE

Further studies are needed in line with the Enhanced Recovery for Cardiac Surgery (ERCS) protocols with a view to reducing anxiety and opioid use in cardiac surgery patients. The present study investigates the effects of preoperative visits by operating room nurses to patients scheduled for cardiac surgery on postoperative anxiety, pain severity and frequency, and the type and dose of analgesic medication.

DESIGN

This is a quasi-experimental study with a pretest-posttest control group design involving nonrandomized groups.

METHODS

The study was conducted in the Department of Cardiovascular Surgery of a Foundation University Hospital in Turkey between August 20, 2020 and April 15, 2021. Included in the study were patients selected based on a nonprobability sampling approach who met the study inclusion criteria (aged 18-75 years, no psychiatric diagnosis or drug use, first cardiovascular surgery experience, scheduled for elective surgery, up to five coronary anastomoses, literate and able to speak and understand Turkish, undergoing cardiovascular surgery with Cardiopulmonary Bypass (CPB)) determined by the researcher. The treatment group was visited preoperatively by operating room nurses, and followed-up for the first 72 hours after surgery.

FINDINGS

The intervention was effective in reducing postoperative state anxiety levels (P < .05). In the control group, each one-point increase in the preoperative state-anxiety level caused a 9% increase in the length of stay in the intensive care unit (P < .05). Pain severity increased as the preoperative state-anxiety and trait-anxiety levels, and the postoperative state-anxiety levels, increased (P < .05). While there was no significant difference in pain severity, the intervention proved to be effective in reducing pain frequency (P < .05). It was further noted that the intervention reduced the use of opioid and nonopioid analgesics for the first 12 hours (P < .05). The probability of using opioid analgesics increased 1.56 times (P < .05) with each one-point increase in pain severity reported by the patients.

CONCLUSIONS

The participation of operating room nurses in preoperative patient care can contribute to the management of anxiety and pain and the reduction of opioids. It is recommended that such an approach be implemented as an independent nursing intervention given the potential contribution to ERCS protocols.

The Impact of Preoperative Patient Education on Postoperative Pain, Opioid Use, and Psychological Outcomes: A Narrative Review

Background

Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use.

Objectives

The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes.

Method

The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including "preoperative" AND "patient education" AND "elective surgery," limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded.

Results

From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety.

Conclusion

Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.

Nurse-led care after ablation of atrial fibrillation: a randomized controlled trial

AIMS

The added value of advanced practitioner nurse (APN) care after ablation of atrial fibrillation (AF) is unknown. The present study investigates the impact of APN-led care on AF recurrence, patient knowledge, lifestyle, and patient satisfaction.

METHODS AND RESULTS

Sixty-five patients undergoing AF ablation were prospectively randomized to usual care (N = 33) or intervention (N = 32) group. In addition to usual care, the intervention consisted of an educational session, three consultations spread over 6 months and telephone accessibility coordinated by the APN. Primary outcome was the AF recurrence rate at 6-month follow-up. Secondary outcomes were lifestyle factors (alcohol intake, exercise, BMI, smoking), patient satisfaction and AF knowledge measured at 1 and 6 months between groups and within each group. Study demographics at 1 month were similar, except AF knowledge was higher in the intervention group (8.6 vs. 7, P = 0.001). At 6 months, AF recurrence was significantly lower in the intervention group (13.5 vs. 39.4%, P = 0.014). Between groups, patient satisfaction and AF knowledge were significantly higher in the intervention group, respectively, 9.4 vs. 8.7 (P < 0.001) and 8.6 vs. 7.0 out of 10 (P < 0.001). Within the intervention group, alcohol intake decreased from 3.9 to 2.6 units per week (P = 0.031) and physical activity increased from 224.4 ± 210.7 to 283.8 ± 169.3 (P = 0.048). No changes occurred within the usual care group. Assignment to the intervention group was the only protective factor for AF recurrence [Exp(B) 0.299, P = 0.04] in multivariable-adjusted analysis.

CONCLUSION

Adding APN-led care after ablation of AF improves short-term clinical outcome, patient satisfaction and physical activity and decreases alcohol intake.

Effectiveness of virtual reality in reducing preoperative anxiety in adults: A systematic review and meta-analysis

AIM

To evaluate the impact of a virtual reality (VR) intervention on adult patients' preoperative anxiety, heart rate, respiration rate and blood pressure.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify research studies in English or Chinese on RCTs from their inception to 31 May 2022. Detailed search strategies and the checklist are provieded in Supplementary files S1 and S2.

REVIEW METHODS

Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test.

RESULTS

This study included 11 articles with a total of 892 participants. VR distraction comprised five studies, and VR exposure consisted of six studies. The results indicated that VR could reduce preoperative anxiety in adult patients and VR exposure seems to be more effective. The results also indicated that VR intervention can effectively reduce patients' heart rate and blood pressure compared to traditional intervention methods, but had no significant effect on respiration rate.

CONCLUSION

VR technology could relieve preoperative anxiety in adult patients through distraction or exposure. More well-designed RCTs containing a wider range of surgical types are needed to verify our findings before we can make strong recommendations.

IMPACT

Our systematic review and meta-analysis show a positive effect of VR distraction and exposure interventions in reducing preoperative anxiety in adult patients. We suggest incorporating VR into preoperative procedures as an auxiliary way to reduce negative emotions in eligible patients.

NO PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis and such details do not apply to our work.

Potential mechanisms of multimodal prehabilitation effects on surgical complications: a narrative review

Continuous advances in prehabilitation research over the past several decades have clarified its role in improving preoperative risk factors, yet the evidence demonstrating reduced surgical complications remains uncertain. Describing the potential mechanisms underlying prehabilitation and surgical complications represents an important opportunity to establish biological plausibility, develop targeted therapies, generate hypotheses for future research, and contribute to the rationale for implementation into the standard of care. In this narrative review, we discuss and synthesize the current evidence base for the biological plausibility of multimodal prehabilitation to reduce surgical complications. The goal of this review is to improve prehabilitation interventions and measurement by outlining biologically plausible mechanisms of benefit and generating hypotheses for future research. This is accomplished by synthesizing the available evidence for the mechanistic benefit of exercise, nutrition, and psychological interventions for reducing the incidence and severity of surgical complications reported by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This review was conducted and reported in accordance with a quality assessment scale for narrative reviews. Findings indicate that prehabilitation has biological plausibility to reduce all complications outlined by NSQIP. Mechanisms for prehabilitation to reduce surgical complications include anti-inflammation, enhanced innate immunity, and attenuation of sympathovagal imbalance. Mechanisms vary depending on the intervention protocol and baseline characteristics of the sample. This review highlights the need for more research in this space while proposing potential mechanisms to be included in future investigations.

The effect of discharge training with the teach-back method on post-discharge challenges in lumbar disc herniation patients: A quasi-experimental study

BACKGROUND

Shortened length of hospital stay in patients undergoing lumbar disc herniation surgery forces to undertake interventions that facilitate optimal patient outcomes.

AIM

The aim of this study was to investigate the effect of discharge training given by teach-back method, and counseling based on individual needs and a study-specific training booklet on postoperative pain and challenges experienced by lumbar disc herniation patients.

METHODS

This study had a quasi-experimental design and was conducted with 94 patients. Patients were divided into a control group (n = 48) and an intervention group (n = 46) using the blocking method. The pain was assessed at the time of patient admission, at discharge, and at follow-up; postoperative challenges were evaluated at discharge and follow-up.

RESULTS

Most patients experienced pain and challenges such as kinesiophobia, weakness-exhaustion-fatigue, irritability, constipation, and insomnia. The patients in the intervention group had less back and leg pain and challenges.

CONCLUSIONS

The benefits of education given by teach-back method, and counseling in reducing the postoperative problems experienced by patients who underwent surgery for lumbar disc herniation were demonstrated in this study. The findings suggest that study-specific training and counseling may be useful for addressing the pain and challenges of patients with lumbar disc herniation.

Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized Controlled Trial

BACKGROUND

Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop.

AIM

This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery.

METHOD

A randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests.

RESULTS

The findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction.

CONCLUSIONS

The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.

Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review

OBJECTIVE

The objective of this scoping review was to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting elective coronary artery bypass grafting surgery. This review also sought to report feasibility and patient experiences to shape clinical practice and underpin a future systematic review.

INTRODUCTION

As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing coronary artery bypass grafting. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's ability to withstand upcoming physiologic stress and, thus, avoid postoperative complications.

INCLUSION CRITERIA

Studies that included adult patients awaiting coronary artery bypass grafting surgery at home and that described interventions optimizing preoperative physical and psychological health in any setting were included.

METHODS

The JBI methodology for conducting scoping reviews was used to identify relevant studies in MEDLINE, CINAHL, Cochrane Library, Embase, Scopus, SweMed+, PsycINFO, and PEDro. Gray literature was identified searching Google Scholar, ProQuest Dissertations and Theses, MedNar, OpenGrey, NICE Evidence search, and SIGN. Studies in Danish, English, German, Norwegian, and Swedish were considered for inclusion, with no geographical or cultural limitations, or date restrictions. Two independent reviewers screened titles and abstracts, and studies meeting the inclusion criteria were imported into Covidence. Sixty-seven studies from November 1987 to September 2022 were included. The data extraction tool used for the included papers was developed in accordance with the review questions and tested for adequacy and comprehensiveness with the first 5 studies by the same 2 independent reviewers. The tool was then edited to best reflect the review questions. Extracted findings are described and supported by figures and tables.

RESULTS

Sixty-seven studies were eligible for inclusion, representing 28,553 participants. Analyses of extracted data identified various preoperative interventions for optimizing postoperative and psychological outcomes for adult patients awaiting elective coronary artery bypass grafting surgery. Based on similarities, interventions were grouped into 5 categories. Eighteen studies reported on multimodal interventions, 17 reported on psychological interventions, 14 on physical training interventions, 13 on education interventions, and 5 on oral health interventions.

CONCLUSION

This scoping review provides a comprehensive summary of strategies that can be applied when developing a prehabilitation program for patients awaiting elective coronary artery bypass surgery. Although prehabilitation has been tested extensively and appears to be feasible, available evidence is mostly based on small studies. For patients undergoing elective coronary artery bypass grafting to derive benefit from prehabilitation, methodologically robust clinical trials and knowledge synthesis are required to identify optimal strategies for patient selection, intervention design, adherence, and intervention duration. Future research should also consider the cost-effectiveness of prehabilitation interventions before surgery. Finally, there is a need for more qualitative studies examining whether individual interventions are meaningful and appropriate to patients, which is an important factor if interventions are to be effective.

Evaluating the Effect of Preoperative Provision of Information on Salivary Cortisol in Patients Undergoing Breast Cancer Surgery: A Randomized Controlled Study

PURPOSE

Surgery is considered to be an anxious experience and most patients experience preoperative anxiety. Preoperative awareness has long been one of the most effective ways to reduce fear and anxiety caused by surgery. The aim of this study was to determine the effect of preoperative provision of information on salivary cortisol in candidates for breast cancer surgery.

DESIGN

This randomized clinical trial was conducted on 80 patients (divided into control group and intervention group; 40 patients in each group) admitted to the surgery department of the Cancer Institute of Imam Khomeini hospital in Iran. Samples were selected using random allocation method with a block size of four. Data were collected on participants' demographic characteristics and salivary cortisol.

METHODS

The educational intervention for patients in the control group was routine training and for patients in the intervention group was based on the training booklet approved by cancer specialists. Findings were analyzed using SPSS software version 21.

FINDINGS

The mean age of participants in the intervention and control groups was 44.00 ± 11.45 and 42.62 ± 12.83 years, respectively . The mean score of anxiety in the intervention group was 18.85± 6.19 before intervention, and decreased to 7.40± 3.68 after intervention . The mean score of anxiety in the control group was 19.75 ± 7.26 and significantly decreased to 14.25 ± 5.73 at the end of the study.

CONCLUSIONS

The results showed that preoperative anxiety significantly decreased in both groups, but was lower overall in the intervention group. In fact, using an educational booklet to raise awareness about patients' health, surgery knowledge and postoperative care as well as how to adapt to postsurgery physical changes and to promote psychological support can reduce patients' anxiety. Hence, providing education to patients may be integrated as a complementary method in patients' routine education.

Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery

INTRODUCTION

Quality of care delivery may improve patient outcomes post-bariatric surgery. We examined the quality of post-discharge phone calls (Ph_DC) to determine the impact on early (< 90 day) non-urgent hospital returns (NUHR) following primary bariatric surgery.

METHODS

A retrospective review was performed on patients who underwent Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2019. Patients were compared between presence of care coaching (Jan-June 2019) versus no care coaching (July-Dec 2019). Baseline demographics, comorbidities, psychiatric history, and Ph_DC were collected. Index Ph_DCs were coded for completeness using a scoring system and rated by call quality. Patients were stratified into NUHR versus control group (Never returns [NR]). Primary analysis examined the impact of Ph_DC on NUHR. Sub-analysis examined the impact of call quality. Univariate analysis was performed using Chi-square or Fisher's exact tests. Multivariate analysis (MVA) was used to determine predictors of NUHR. A p-value of ≤ 0.05 was statistically significant.

RESULTS

A total of 359 patients were included. Compared to the NR group (n = 294), NUHRs (n = 65) were more likely to be younger (41.3 + 12.1 versus 45.0 + 10.8 years, p = 0.024), with baseline anxiety (41.5% versus 23.5%, p = 0.003), and undergo RYGB (73.3% versus 57.8%, p = 0.031). There was a significant difference in number of Ph_DC in the NUHR and NR groups (p = 0.0206). Care-coached patients had significantly higher rates of high-quality phone calls (p < 0.0001) compared to non-care-coached patients. MVA demonstrated younger age (OR = 0.97, CI: 0.95-1.00; p = 0.023), anxiety (OR = 2.09, CI: 1.17-3.73; p = 0.012), RYGB (OR = 1.88, CI: 1.02-3.45; p = 0.042), and > 50% call quality versus no Ph_DC (OR = 0.45, CI: 0.25-0.83; p = 0.010) were independently associated with NUHRs.

CONCLUSION

High-quality Ph_DCs may play a role in mitigating NUHRs. Care coaching represents a potential intervention to decrease high rates of NUHR in primary bariatric surgery patients.

Psychoeducation Programs to Reduce Preoperative Anxiety in Adults: A Scoping Review

BACKGROUND

Surgical procedure is a critical event that causes anxiety for patients. One of the possible intervention strategies to reduce anxiety in the preoperative period is psychoeducation.

METHODS

A scoping review was conducted according to the JBI methodology and PRISMA-ScR to map knowledge about psychoeducation programs to reduce preoperative anxiety in adults. The data were extracted by the researchers, according to the objective of the study. Finally, the data synthesis was presented in narrative format and tables.

RESULTS

four studies were included in the review with different characteristics of psychoeducation programs. The approach of these programs consisted of teaching about anxiety, instruction and training in anxiety control techniques. The contents referred to included the surgical process and intervention techniques to reduce anxiety. Program sessions lasted from 45 to 150 min, with a frequency of 1 to 6. The assessment instrument used was the State-Trait Anxiety Inventory. The dynamisers were nurses, psychotherapists and clinical psychologists.

CONCLUSIONS

Psychoeducation programs can be useful and effective in reducing anxiety. More studies are needed to confirm these results.

Educational approaches for patients with heart surgery: a systematic review of main features and effects

Introduction

Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery.

Method and materiel

A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Results

A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong.

Conclusion

The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.

Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump

OBJECTIVE

To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay.

DESIGN

A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence.

METHODS

Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method.

RESULTS

The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions.

CONCLUSIONS

Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.

Expressive Arts Therapy Combined with Progressive Muscle Relaxation following Music for Perioperative Patients with Gynecological Malignancies: A Pilot Study

Objective

We aimed to assess the impact of an expressive arts therapy combined with progressive muscle relaxation following music on mental health (anxiety and hope) in patients with gynecological malignancies undergoing surgery.

Methods

This was a nonrandomized controlled trial. Eligible patients had a primary or recurrent gynecological malignancy scheduled to be treated with surgery. The intervention consisted of three sessions (preoperation, postoperation, and predischarge) during the perioperative period. Firstly, before starting the first session of intervention, all patients completed three questionnaires including a Hospital Anxiety and Depression Scale (HADS), a Herth Hope Index (HHI), and a State Anxiety Inventory (SAI), and the intervention group patients also had to complete the SAI questionnaire again after completing the intervention. Secondly, after the second session of intervention, all patients completed the SAI questionnaire, with the intervention group completed the SAI questionnaire before the intervention. Thirdly, after the third session of intervention, all patients completed HHI and SAI questionnaires, with the intervention group completed the SAI questionnaire before the intervention. Also, to subjectively rate the benefit of expressive arts therapy, the intervention group additionally completed a separate, supplemental questionnaire.

Results

A total of 116 patients were enrolled and 110 included in the final analysis. No group differences were found for HHI scores between the intervention and control participants (Cohen's d = 0.19, P=0.31), although there was a substantial improvement in intervention participants' HHI scores compared to the standard care control participants. There was a statistically significant improvement in intervention participants' SAI from preintervention to postintervention of preoperation (Cohen's d = −0.23, P=0.002) and postoperation (Cohen's d = −0.34, P ≤ 0.001). However, no differences were observed for the predischarge period (Cohen's d = −0.09, P=0.118). Besides, a supplemental questionnaire indicated that 52 (98%) patients felt that expressive arts therapy was beneficial.

Conclusions

Expressive art therapy combined with progressive muscle relaxation under music may be of some effect on alleviating perioperative anxiety in patients with gynecologic malignancies. Therefore, further relevant studies with large samples and multicenters are urgently needed to provide a reliable evidence-based basis for perioperative psychological care of patients with gynecologic malignancies and to promote rapid recovery of patients. It is recommended that further art therapy studies to examine the impact of patient-tailored arts therapy interventions on spiritual well-being in patients with gynecological malignancies, especially in the perioperative period.

The effects of aromatherapy on patients undergoing coronary angiography: A systematic review of clinical trials

As a diagnostic and therapeutic technique for coronary artery disease, angiography is usually associated with some disorders and complications such as fear, pain, discomfort, limited mobility, and anxiety. The present study is a systematic review determining the effects of aromatherapy with different plants in patients undergoing angiography. This review was conducted according to the 06-PRISMA guideline and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-Analysis Facility (SyRF) database. The English databases were Google Scholar, PubMed, Scopus, Web of Science, EBSCO, and ScienceDirect to search articles regarding the effects of aromatherapy with different plants in patients experiencing angiography without a date limitation. The searched keywords in this study were "aromatherapy", "angiography", "coronary artery disease", "anxiety", "stress", and "cardiovascular diseases". Out of 1835 papers, 20 papers up to 2021, met the inclusion criteria for discussion in this systematic review with the data extracted. Most studies were intended to evaluate the effect of aromatherapy on patients’ anxiety with coronary artery bypass graft surgery (11 papers, 55.0%). The most widely used essential oil belonged to the lavender essential oil (13 papers, 65.0%). The results of the current review confirmed that aromatherapy management with lavender, damask rose, orange, and peppermint is able to significantly decrease anxiety, pain, nausea and vomiting, sleep quality, hemodynamic indices, blood pressure, etc. in patients with coronary angiography. However, more investigation is required to confirm the precise mechanisms and side effects of the alternative treatment.

Effect of an mHealth self-help intervention on readmission after adult cardiac surgery: Protocol for a pilot randomized controlled trial

Aim

To describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery.

Design

A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278).

Methods

Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored ‘GoShare’ mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery.

Discussion

Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations.

Impact

This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808.

The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial

Background

Family-centered care has been considered as a philosophy of care. Family presence in intensive care units (ICUs), especially in the acute phase of the disease is controversial. This study has been carried out in order to determine the effect of the family presence on anxiety and agitation in patients undergoing coronary artery bypass grafting (CABG).

Materials and methods

In a clinical trial, 70 patients were randomly allocated into groups of experimental and control. In the experimental group, during the weaning process from the mechanical ventilation, a family member was present at the bedside. The degree of anxiety and Richmond’s Agitation and Sedation Scale (RASS) were compared in seven consecutive time stages, including the time of entry into the ICU, the first respiratory drive, the family entrance, 20 min and 1 h after the presence of the family member, the time of extubation, and 1 h after extubation.

Results

There was a significant difference between the two groups in the mean scores of the anxiety scale in the first (P =0.008), second (P=0.002), and third stages (P =0.005). This difference was not significant in the fourth to seventh stages (P>0.05). As the baseline anxiety levels were different, a covariate adjustment was used for comparisons between treatments, adjusting the main analyses for baseline anxiety levels. Analysis showed that groups were not different. Also, there was no significant difference in the mean scores of RASS between the two experimental and control groups at any of the seven stages (P> 0.05).

Conclusion

According to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries.

Trial registration

This study has been registered in the Iranian Registry of Clinical Trials with the code IRCT201609014299N4.

Roles of Nursing in the Management of Geriatric Cardiovascular Diseases

The nursing field occupies the largest secion of the cardiovascular healthcare services. Despite this, the roles of nursing within the cardiovascular healthcare system has not been well displayed. The authors searched PubMed and Embase (between January 1, 1950, and June 17, 2021) and created a narrative review of recent publications regarding the role of nursing in the management of geriatric cardiovascular disease (CVD). Patients with geriatric CVD, which includes mainly myocardial ischemia and heart failure, were enrolled. Nursing can improve the outcomes of myocardial ischemia and heart failure. It plays a pivotal role in the recovery, rehabilitation, and outcomes of geriatric CVD, especially for chronic heart diseases. Taken together, this paper compiled is focused on the current status of cardiovascular nursing and may facilitate future treatment and rehabilitation in geriatric CVD.

Patient understanding of and participation in infection-related care across surgical pathways: a scoping review

OBJECTIVE

To explore the existing evidence on patient understanding of and/or participation in infection-related care in surgical specialties.

METHOD

A scoping review of the literature was conducted. PubMed, Web of Science, Scopus, and grey literature sources were searched using predefined search criteria for policies, guidelines, and studies in the English language. Data synthesis was done through content and thematic analysis to identify key themes in the included studies.

RESULTS

The initial search identified 604 studies, of which 41 (36 from high-income and five from low- and middle-income countries) were included in the final review. Most of the included studies focused on measures to engage patients in infection prevention and control (IPC) activities, with few examples of antimicrobial stewardship (AMS) engagement strategies. While patient engagement interventions in infection-related care varied depending on study goals, surgical wound management was the most common intervention. AMS engagement was primarily limited to needs assessment, without follow-up to address such needs.

CONCLUSION

Existing evidence highlights a gap in patient participation in infection-related care in the surgical pathway. Standardization of patient engagement strategies is challenging, particularly in the context of surgery, where several factors influence how the patient can engage and retain information. Infection-related patient engagement and participation strategies in surgery need to be inclusive and contextually fit.

Multimedia in preoperative patient education for adults undergoing cancer surgery: A systematic review

PURPOSE

The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients.

METHODS

A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design.

RESULTS

The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods.

CONCLUSIONS

In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.

Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)

PURPOSE

Preoperative psychological factors have an impact on postoperative outcomes and there is a paucity of research in vascular surgery. The objective of this study was to examine the impact of preoperative psychological factors on short-term postoperative outcomes in an infrarenal endovascular aneurysm repair (EVAR) cohort.

METHODS

A prospective, multi-centre observational study was conducted across three vascular units in England. English-speaking participants who were older than 18 years, able to provide informed consent and awaiting an elective standard infrarenal EVAR were eligible for the study. A total of 46 patients undergoing elective infrarenal AAA repair were assessed preoperatively with the State Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI-II) and Life Orientation Test-Revised (LOT-R). Data on five short-term postoperative outcomes was collected and analysed using Spearman's rank correlations.

RESULTS

Higher preoperative anxiety levels (ρ = 0.38, p = 0.01), and depression scores (ρ = 0.36, p = 0.02) were moderately correlated with an increased length of postoperative critical care stay. Higher levels of preoperative depression were moderately correlated with greater postoperative opioid analgesia use (ρ = 0.34, p = 0.02). No correlation was witnessed between optimism scores and postoperative outcomes. No correlation was witnessed with respect to total length of stay, number of complications, or time to mobilisation.

CONCLUSIONS

There is a potential link between preoperative psychological well-being and short-term postoperative outcomes in an EVAR cohort. Further work is necessary to validate this link and examine the role of preoperative interventions in optimising the psychological well-being of patients undergoing EVAR.

Enhancing Family-Centered Care in Cardiothoracic Surgery

The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to stress over health care costs and lost wages. Patients are at risk for developing post-intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.

Effects of foot massage and patient education in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial

BACKGROUND

Anxiety, pain, and fatigue are common postoperative problems that disturb the recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. These postoperative problems are associated with prolonged recovery and decreased quality of life. This study was aimed at evaluating the combined effects of foot massage and patient education on anxiety, fatigue, pain, self-efficacy, and quality of life in patients undergoing CABG surgery.

MATERIAL AND METHODS

In this randomized controlled trial (RCT), 130 participants were randomly allocated to experimental (n = 65) and control (n = 65) groups. The experimental group received a combination of foot massage and patient education as interventions and the control group received usual care of the hospital.

RESULTS

The experimental group had a significant decrease in anxiety (p = 0.001), fatigue (p = 0.001), pain (p = 0.001), and increased self-efficacy (p = 0.001) and quality of life (p = 0.001).

CONCLUSION

The combined form of foot massage and patient education is effective in decreasing anxiety, fatigue, pain, and increasing self-efficacy and the quality of life. These interventions will support the recovery of patients and reduce their suffering.

Preoperative individualized education intervention reduces delirium after cardiac surgery: a randomized controlled study

Background

Postoperative delirium dramatically increases the mortality and morbidity of patients undergoing cardiac surgery. Preoperative education has been proven to be effective in improving recovery and reducing complications. However, there is rare evidence of individualized education for the delirium. This study aimed to investigate the effect of preoperative personalized education on postoperative delirium of patients undergoing cardiac surgery.

Methods

A total of 133 adult patients receiving cardiac surgery in a single center were enrolled in this study and randomized into the experimental group (n=67) and the control group (n=66), who were given the preoperative individualized education intervention and routine care respectively. The primary endpoint of delirium and other clinical outcomes were observed and compared.

Results

All patients completed this trial without a significant difference between the two groups in baseline characteristics. The incidence of the delirium of the experimental group was significantly lower than that of the control group (10.4% vs. 24.2%, P=0.038). There was no statistical difference between two groups in hospital-stay and other complications, while the mechanical ventilation time and ICU stay of the experimental group was significantly lower (MV time: 13.7±7.6 vs. 18.6±9.8 h, P=0.002; ICU stay: 31.3±9.1 vs. 36.5±10.4 h, P=0.003).

Conclusions

Preoperative individualized education intervention can reduce the incidence of postoperative delirium and promote the recovery of patients receiving cardiac surgery.

Client perceptions of the value of veterinary anesthesiologist involvement with anesthesia and pain management, benefits of a preanesthetic consultation, and quality of care for dogs undergoing elective orthopedic surgery

OBJECTIVE

To compare perceptions related to veterinary anesthesiologist involvement with anesthesia and pain management, benefits of a preanesthetic consultation (PAC) with an anesthesiologist, and quality of patient care between clients who did and did not participate in a PAC prior to their dogs' elective orthopedic surgery.

SAMPLE

80 dog owners.

PROCEDURES

Owners of dogs undergoing elective stifle joint surgery participated in the study. Participants were randomly assigned to PAC and control groups (n = 40 participants/group). The PAC group participated in a PAC with an anesthesiologist and completed a written survey (12 items with Likert-type response options). The control group completed a similar survey (identical except for 2 statements related to the PAC experience) without participating in a PAC. Results were compared between groups by statistical methods.

RESULTS

The proportion of clients in the PAC group who strongly agreed with the statements that a PAC was beneficial, their questions about the pet's anesthesia and pain management plan were answered, they knew who would perform anesthesia and what safeguards were in place, veterinary specialty hospitals should have an anesthesiologist on staff, they were willing to pay more to have an anesthesiologist supervise the anesthesia and pain management, and a PAC with an anesthesiologist should be standard of care in veterinary medicine was greater than that for control group clients. Responses to quality-of-care items did not differ between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Participating in a PAC was associated with more positive perceptions of anesthesiologists and knowledge about the anesthesia plan. Further research with a validated survey instrument is needed to confirm these findings.

The effect of a structured patient education intervention on the quality of life for coronary artery bypass grafting patients: A prospective randomised controlled study

This study aimed to determine the effectiveness of structured patient education on the quality of life for coronary artery bypass grafting patients. The research included 80 patients (40 control, 40 experimental) who underwent coronary artery bypass graft surgery at the cardiovascular surgery ward of a university hospital in Western Turkey and met the criteria to be included in the sample. The following documents were used to collect data: Patient Information Form, Knowledge Level Form and SF36 Quality of Life Scale. It was determined that the structured planned patient education for coronary artery bypass grafting patients effectively improved the patients' knowledge level and quality of life.

The Influence of Preoperative Anxiety, Optimism, and Pain Catastrophizing on Acute Postoperative Pain in Patients Undergoing Cardiac Surgery: A Cross-sectional Study

BACKGROUND

Acute postoperative pain (APOP) may cause complications and delay healing. Analgesics alone cannot completely relieve APOP. Preoperative anxiety, optimism, and pain catastrophizing are predictors of APOP. No study author has examined the mediating effect of pain catastrophizing on APOP in patients undergoing cardiac surgery.

OBJECTIVE

The aims of this study were to investigate the relationship between preoperative anxiety, optimism, pain catastrophizing, confounding factors (age, sex, type of surgery, and preoperative pain), and APOP and to examine the mediating effect of pain catastrophizing.

METHODS

The authors of this cross-sectional study used a convenience sampling method and included 100 adults undergoing cardiac surgery in a southern Taiwanese medical center. The patients were asked to complete the State-Trait Anxiety Inventory-State subscale, Pain Catastrophizing Scale, and Life Orientation Test-Revised questionnaires before surgery. Postoperatively, the patients were asked to report their pain intensity on a numerical rating scale. Results were analyzed using SPSS version 22.

RESULTS

Patients had a mild level of anxiety, a moderate level of optimism, and pain catastrophizing before surgery, as well as a moderate level of APOP. Men reported lower levels of APOP than women (z = -2.0, P < .05). APOP was significantly associated with preoperative anxiety (r = 0.48, P < .01), optimism (r = -0.45, P < .01), and pain catastrophizing (r = 0.65, P < .01). Only pain catastrophizing was a significant predictor of APOP (β = 0.60, P < .001) and fully mediated the relationship between anxiety and APOP (z = 4.92, P < .001). The final model explained 42% of the variance in APOP.

CONCLUSIONS

Pain catastrophizing should be assessed before surgery. Reducing pain catastrophizing would decrease APOP and improve the quality of pain management.

Relationship between emotional states before cardiac valve surgeries with postoperative complications

OBJECTIVE

To investigate associations between preoperative anxiety and depression symptoms and postoperative complications and the sociodemographic and clinical characteristics of patients undergoing valve repair surgery.

METHOD

Observational, exploratory and prospective study. The consecutive non-probabilistic sample consisted of patients undergoing their first valve repair surgery. Data were collected from September 2013 to September 2015, in a university hospital in the interior of São Paulo, Brazil. Symptoms were assessed using the Hospital Anxiety and Depression Scale and analyzed using Mann-Whitney and Spearman correlation; alpha was established at 5%.

RESULTS

Among the 70 participants, depressive symptoms were more frequent among women (p=0.042) and among patients experiencing postoperative agitation (p=0.039) Conclusion: In this study, depressive symptoms were associated with being a woman and postoperative agitation; the same was not true in regard to anxiety symptoms.

Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial

BACKGROUND

Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members.

OBJECTIVE

To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients' anxiety and depression.

TRIAL DESIGN

Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation.

PARTICIPANTS

100 elective coronary artery bypass grafting±valve surgery patients and their family members.

INTERVENTIONS

Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control).

OUTCOMES

Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0-100), respectively; change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery.

RESULTS

Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient's anxiety scores over time (MD -1.7, 95% CI -3.5 to 0.0). However, there was no evidence of a treatment effect on patient's depression scores over time (MD -0.6, 95% CI -2.3 to 1.2).

CONCLUSION

Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients' anxiety levels.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15006971.

Preoperative exercise and recovery after cardiac surgery: a meta-analysis

BACKGROUND

To evaluate the association between preoperative exercise and recovery after cardiac surgery.

METHODS

Literature comparing preoperative exercise and the control group for patients receiving cardiac surgery was retrieved in multiple databases. Review Manager 5.2 was adopted for meta-analysis, sensitivity analysis and bias analysis.

RESULTS

Finally, 6 relevant studies satisfied the inclusion criteria. There was significant difference in length of stay in intensive care unit (ICU) (MD- = 1.35, 95%CI [- 2.64, - 0.06], P = 0.04; P for heterogeneity < 0.0001, I2 = 88%) and physical function after operation (P of heterogeneity = 0.32, I2 = 12%, Z = 9.92, P of over effect< 0.00001). The meta-analysis suggested that there was no significant difference in white blood cell count (WBC) at postoperative day 7 and mental health after operation between the exercise group and the control group. Limited publication bias was observed in this study.

CONCLUSION

Preoperative exercise including inhaled muscle training, aerobics, resistance training and stretching could promote recovery after cardiac surgery.

Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education

OBJECTIVE

This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG).

METHODS

In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge.

RESULTS

A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η² = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η² = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group.

CONCLUSION

Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge.

PRACTICE IMPLICATION

Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.

Improving postoperative patient reported benefits and satisfaction following spinal fusion with a single preoperative education session

BACKGROUND CONTEXT

Patient expectations have been demonstrated to influence recovery following spine surgery. Addressing patient expectations specifically in regards to pain and postsurgical healing is an important factor in improving recovery patterns. Presurgical education can potentially help manage patient expectations.

PURPOSE

The primary objective was to determine if participation in a single preoperative multidisciplinary educational session would result in reduced patient dissatisfaction with surgical expectations. A secondary objective was to determine if participation resulted in improvements in postsurgical pain, disability, and reductions in emergency room visits following surgery.

STUDY DESIGN

A retrospective cohort study utilizing data from the Canadian Spine Outcomes and Research Network (CSORN) registry and hospital electronic medical records.

PATIENT SAMPLE

Participants were patients receiving elective spinal fusion for 2-5 levels (N=206). Cohort 1 included patients who participated in preoperative multidisciplinary education (n=103). Cohort 2 included patients who opted out of the educational session (n=103).

OUTCOME MEASURES

Outcomes measured included the Oswestry Disability Index (ODI), NRS scales for back and leg pain (NRS-B/NRS-L), CSORN questions pertaining to patient satisfaction with surgery and whether or not the surgery met expectations. Electronic chart review quantified emergency room visits following surgery.

METHODS

Spinal fusion patients are encouraged to attend a one time, two-hour education session 3-6 weeks prior to their surgery. The education session includes interactive discussions with nursing, physiotherapy, and occupational therapy staff concentrating on what patients should expect, how to best prepare for surgery and proper care postsurgery. A one-way ANOVA was conducted for continuous variables of interest (age, number of levels operated on, ASA score, and number of visits to the emergency room following surgery). Chi-squared analysis was conducted for categorical variables of interest (pathology, gender, patient satisfaction, and patient expectations). A two (Cohort; education: no education) × 2 (Time; baseline: follow-up) repeated measure ANOVA was conducted for NRS-B, NRS-L, and ODI. Significance was set at p<.05.

RESULTS

Patients (n=103) who took part in the presurgical education sessions were significantly more satisfied with their surgery compared to the control cohort (p=.014). Patients (n=103) who did not participate in the education session failed to have their expectations met in terms of improvement in daily activities (p=.03), improvement in walking capacity (p=.03) and their expectation of back pain reduction (p=.001). There was a statistically significant effect of participation in the educational session reducing postoperative back pain (p=0.03), although this improvement did not reach a minimally clinically important difference. Number of visits to the emergency room in the 12 weeks following spine surgery was significantly lower (p=.04) for patients in the education cohort.

CONCLUSIONS

Reduced emergency room utilization, improved patient satisfaction, achievement of expected improvements and alleviation of back pain were documented with greater success following participation in a single 2-hour educational session prior to surgery. A single education session is a viable tool for improving patient outcomes due to its low administrative burden.

Attitudes of Spine Surgeons Regarding Management of Preoperative Anxiety: A Cross-sectional Study

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVE

To investigate spine surgeons' attitudes regarding preoperative anxiety measurement, management, and responsibility.

SUMMARY OF BACKGROUND DATA

The vast majority of patients scheduled for spine surgery experience preoperative anxiety. However, there are currently no consensus guidelines for measure or management of preoperative anxiety in spinal operations.

MATERIALS AND METHODS

An anonymous questionnaire was sent online to spine surgeons of AO Spine North America to capture their views regarding preoperative anxiety.

RESULTS

Of 69 complete responses, most respondents were male (n=66, 95.7%), orthopedic surgeons (n=52, 75.4%), and practicing at an academic setting (n=39, 56.5%). Most spine surgeons practiced for at least 20 years (n=52, 75.4%), operated on 100-300 patients per year (n=48, 69.6%), and were attending physicians (n=61, 88.4%). Most did not measure preoperative anxiety (n=46, 66.7%) and would not use a rating scale to measure it (n=38, 55.1%). However, most would discuss it if mentioned by the patient (n=40, 58.0%). Other spine surgeons measured anxiety verbally (n=22, 31.9%) or with a rating scale or survey (n=6, 8.7%). Although preferences for preoperative anxiety management varied, most respondents used patient education (n=54, 78.3%) and permitting family members' presence (n=36, 52.2%) to reduce patient anxieties. Spine surgeons held themselves, anesthesiologists, and patients most responsible to manage preoperative anxiety.

CONCLUSIONS

The majority of spine surgeons surveyed did not regularly measure preoperative anxiety, but would discuss its management if the subject was broached by the patient. Spine surgeons relied on a variety of methods to manage a patient's anxiety, but most preferred preoperative education and permitting the presence of family members. Responsibility for controlling preoperative anxiety was chiefly allocated to surgeons, anesthesiologists, and patients. Future avenues for research may include developing a preoperative anxiety measurement scale and management protocol specific to spine surgery.

LEVEL OF EVIDENCE

Level IV.

Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries

OBJECTIVE

to investigate the associations of preoperative anxiety and depression symptoms with postoperative complications and with sociodemographic and clinical characteristics of patients submitted to the first coronary artery bypass graft.

METHOD

observational, analytical and longitudinal study. A consecutive non-probabilistic sample consisted of patients submitted to coronary artery bypass graft. To evaluate the symptoms, the Hospital Anxiety and Depression Scale was used. tracheal intubation for more than 48 hours, hemodynamic instability, sensorineural deficit, agitation, hyperglycemia, infection, nausea, vomiting, pain and death were classified as complications. The Mann-Whitney and Spearman Correlation tests were used, with a significance level of 0.05.

RESULTS

a total of 75 patients participated. The group that presented hemodynamic instability in the postoperative period had a greater median for the anxiety symptoms (p = 0.012), as well as the women (p = 0.028). The median of the depression symptoms was higher in the group presenting nausea (p = 0.002), agitation (p <0.001), tracheal intubation for more than 48 hours (p = 0.018) and sensorineural deficit (p = 0.016).

CONCLUSION

there was association of the symptoms of preoperative anxiety with hemodynamic instability in the postoperative period and with the female gender, as well as association of depression symptoms with the following complications: nausea, agitation, time of intubation in the postoperative period and sensorineural deficit.

Randomized Clinical Trial Comparison of the Effect of Verbal Education and Education Booklet on Preoperative Anxiety

PURPOSE

Comparing the effect of verbal education and education booklet on preoperative anxiety.

DESIGN

This study was a randomized clinical trial.

METHODS

Sixty patients were randomly allocated into three groups: control, booklet, and verbal education. The data were collected using Spielberger's State-Trait Anxiety Inventory before and after intervention. SPSS (version 20; IBM, Armonk, NY) with analysis of variance and the dependent t test were used for analysis.

FINDINGS

After intervention, there was a significant difference between the mean scores of state anxiety scale among the intervention groups (booklet and verbal) with the control group (P < .05). The mean difference between the two intervention groups (booklet and verbal) was not significant (P > .05).

CONCLUSIONS

According to the results, and given that nurses work under time pressure in Iran and other societies, it is concluded that well-designed education booklets can be used to reduce the preoperative anxiety.

Possible Effect of Video and Written Education on Anxiety of Patients Undergoing Coronary Angiography

PURPOSE

The aim of this study was to investigate possible effects of video and written education on anxiety of patients undergoing coronary angiography.

DESIGN

The study design was quasi-experimental.

METHODS

This randomized controlled semitrial model included patients who underwent coronary angiography between October 2015 and May 2016 at the Department of Cardiology of a university hospital. The number of subjects determined by power analysis was 90 patients in three groups. Written education, video education, and control groups were included. Data were collected using personal information forms, State-Trait Anxiety Inventory, and physiological variables.

FINDINGS

There was a statistically significant difference in the mean scores of state anxiety, satisfaction, and physiological variables after education, compared with baseline, in both patient and control groups (P < .005).

CONCLUSIONS

Our study results suggest that education given by the nurse before the procedure reduces level of anxiety and affects physiological variables positively.

The Effect of Education on the Anxiety Level of Patients Before Thyroidectomy

PURPOSE

The present study aims to evaluate the effect of preoperative education on the level of anxiety provided to patients scheduled for thyroidectomy using education brochures on the level of anxiety.

DESIGN

The study design was quasi-experimental.

METHODS

The study data were collected using the Patient Information Form and the Turkish version of the Anxiety Specific to Surgery Questionnaire (ASSQ). Study group patients were informed by brochure before 24 hours. Control group patients were informed verbally during routine preoperative preparation or 1 day before surgery. Test and control group patients were resubjected to the ASSQ before being transported from their unit beds to the operating room.

FINDINGS

There was no significant difference in the mean scores of the pretest and final test ASSQ scores for the test and control groups (P > .05).

CONCLUSIONS

Our study results showed that education provided to the patients scheduled for thyroid surgery using written materials did not affect anxiety.

Effectiveness of Preoperative Visitation on Postanesthesia Complications

PURPOSE

The purpose of this study was to evaluate the effect of preoperative visitation on postanesthesia complications after hernia surgery.

DESIGN

In this quasi-experimental study, 70 patients receiving elective hernia surgery were purposefully selected.

METHODS

In the evening preceding surgery, the surgical technologist visited the patient in the surgical ward. Data were collected by checklist of vital signs and postanesthesia complications.

FINDINGS

A greater increase is observed in the systolic blood pressure of the experimental group at the moment of entering the postanesthesia care unit. A significant difference was found between groups in the intensity of postanesthesia agitation in the postanesthesia care unit patients, with a higher incidence among the experimental group.

CONCLUSIONS

According to the findings, preoperative education programs for operating room staff and other behavioral and mental interventions to manage surgery and its consequences in elective surgical patients is recommended.

Transitional care services: a quality and safety process improvement program in neurosurgery

OBJECTIVE

Readmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. However, few readmission reduction programs have targeted surgical patient populations. The objective of this study was to establish a transitional care program (TCP) with the goal of decreasing length of stay (LOS), improving discharge efficiency, and reducing readmissions of neurosurgical patients by optimizing patient education and postdischarge surveillance.

METHODS

Patients undergoing elective cranial or spinal neurosurgery performed by one of 5 participating surgeons at a quaternary care hospital were enrolled into a multifaceted intervention. A preadmission overview and establishment of an anticipated discharge date were both intended to set patient expectations for a shorter hospitalization. At discharge, in-hospital prescription filling was provided to facilitate medication compliance. Extended discharge appointments with a neurosurgery TCP-trained nurse emphasized postoperative activity, medications, incisional care, nutrition, signs that merit return to medical attention, and follow-up appointments. Finally, patients received a surveillance phone call 48 hours after discharge. Eligible patients omitted due to staff limitations were selected as controls. Patients were matched by sex, age, and operation type—key confounding variables—with control patients, who were eligible patients treated at the same time period but not enrolled in the TCP due to staff limitation. Multivariable logistic regression evaluated the association of TCP enrollment with discharge time and readmission, and linear regression with LOS. Covariates included matching criteria and Charlson Comorbidity Index scores.

RESULTS

Between 2013 and 2015, 416 patients were enrolled in the program and matched to a control. The median patient age was 55 years (interquartile range 44.5–65 years); 58.4% were male. The majority of enrolled patients underwent spine surgery (59.4%, compared with 40.6% undergoing cranial surgery). Hospitalizations averaged 62.1 hours for TCP patients versus 79.6 hours for controls (a 16.40% reduction, 95% CI 9.30%–23.49%; p < 0.001). The intervention was associated with a higher proportion of morning discharges, which was intended to free beds for afternoon admissions and improve patient flow (OR 3.13, 95% CI 2.27–4.30; p < 0.001), and decreased 30-day readmissions (2.5% vs 5.8%; OR 2.43, 95% CI 1.14–5.27; p = 0.02).

CONCLUSIONS

This neurosurgical TCP was associated with a significantly shorter LOS, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge.