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

Cardiac surgeries pose as an emotional experience for patients. Preoperative education is known to positively alter people’s perceptions, emotions, and mitigate surgical distress. However, this intervention’s effectiveness in improving perioperative outcomes among patients undergoing cardiac surgery lacked rigorous statistical synthesis and remains inconclusive.

The aim was to synthesize the effectiveness of preoperative education on improving perioperative outcomes [anxiety, depression, knowledge, pain intensity, pain interference with daily activities, postoperative complications, length of hospitalization, length of intensive care unit (ICU) stay, satisfaction with the intervention and care, and health-related quality of life] among patients undergoing cardiac surgery.

This systematic review and meta-analysis conducted a comprehensive search of nine electronic databases (PubMed, EMBASE, Scopus, MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, PsycINFO, and ERIC) and grey literature for randomized controlled trials examining the preoperative educational interventional effects on patients undergoing cardiac surgery from inception to 31 December 2020. The studies’ quality was evaluated using Cochrane Risk-of-Bias Tool 1 (RoB1). Meta-analyses via RevMan 5.4 software synthesized interventional effects.

Twenty-two trials involving 3167 participants were included. Preoperative education had large significant effects on reducing post-intervention preoperative anxiety (P = 0.02), length of ICU stay (P = 0.02), and improving knowledge (P < 0.00001), but small significant effect sizes on lowering postoperative anxiety (P < 0.0001), depression (P = 0.03), and enhancing satisfaction (P = 0.04).

This review indicates the feasibility of preoperative education in clinical use to enhance health outcomes of patients undergoing cardiac surgery. Future studies need to explore knowledge outcomes in-depth and more innovative technologies in preoperative education delivery.