The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review.

Joe Arundel,Thomas Wainwright,Louise Burgess

doi:10.3390/healthcare7010048

Joe Arundel, Thomas Wainwright + Show 1 more

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https://doi.org/10.3390/healthcare7010048

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Abstract

Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warranted.

Highlights

Spinal surgery for the treatment of back or neck pain may be considered if conservative strategies are unsuccessful, pain becomes disabling or in cases of progressive neurological deficit and deformity [1].A recent development in spinal surgery has been the systematic application of an evidence-based perioperative care protocol (named “fast-track” or “enhanced recovery after surgery” (ERAS)) [2] which aims to attenuate the surgical stress response and reduce convalescence [3]
It is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; given the low risk profile and promising benefits, future research in this area is warranted
Two papers removed as they were retrospective analyses and one screened patients preoperatively but did were removed as they were retrospective analyses and one screened patients preoperatively not deliver the educational intervention until six weeks after surgery [19]

Summary

Introduction

Spinal surgery for the treatment of back or neck pain may be considered if conservative strategies are unsuccessful, pain becomes disabling or in cases of progressive neurological deficit and deformity [1].A recent development in spinal surgery has been the systematic application of an evidence-based perioperative care protocol (named “fast-track” or “enhanced recovery after surgery” (ERAS)) [2] which aims to attenuate the surgical stress response and reduce convalescence [3]. Spinal surgery for the treatment of back or neck pain may be considered if conservative strategies are unsuccessful, pain becomes disabling or in cases of progressive neurological deficit and deformity [1]. The perception of pain in relation to spinal surgery can be altered by external factors, and psychosocial characteristics related to different degrees of clinical impairment and quality of life in the preoperative period may influence surgical recovery [5]. Factors associated with anxiety and depression both before and after spine surgery are reported to be a greater experience of pain, the need for information, the degree of self-reported disability, employment status (feelings of not being able to contribute to society) and mental health status [8]. The need for information is reported to be a significant theme amongst qualitative studies from spinal surgery, with patients expressing a need for individualized information given in sufficient quantities and at the appropriate time [8]

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