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European Heart Journal 2002 23(8):666-674; doi:10.1053/euhj.2001.2897
Copyright © 2002 by the European Society of Cardiology.
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The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial

C.M. Shuldhamf1, S. Fleming and H. Goodman

Royal Brompton & Harefield Trust, London, U.K.

revised July 10, 2001; accepted July 11, 2001

Abstract

Aims Research has demonstrated the beneficial impact that pre-operative education exerts on the postoperative recovery of patients having surgery but little work has focused specifically on cardiac surgery. Therefore a randomized controlled trial was designed to elucidate the consequences of pre-operative education, given before admission, on postoperative pain, anxiety, depression and wellbeing in the 6 months following a first episode of coronary artery surgery.

Method and Results Three hundred and fifty-six people were randomized into the study, with 188 in the experimental and 168 in the control arms. Patients in the experimental group received the intervention, a day of education by members of the multidisciplinary team, prior to admission for surgery. Experimental and control subjects had the usual care, which involved education on admission and throughout their stay in hospital. Measurement was conducted on entry to the study, before randomization, and at 3 days, 6 weeks, 3 months and 6 months following operation. A variety of tools were used: the SF-36 Health Status questionnaire, the Hospital Anxiety and Depression scale, the General Well-Being questionnaire and a pain measurement tool. Analysis was done using the intention-totreat principle and non-parametric statistics. There were no significant differences between groups in the primary outcomes namely anxiety (P=0·09) and pain (P=0·48), or in depression (P=0·62) and wellbeing (‘worn out’ P=0·11; ‘tense and uptight’ P=0·29) 6 months after operation. This was also the case 3 days after coronary artery surgery. There was a significant difference in length of hospital stay (P=0·01) with the experimental group having the longer stay. These findings contrast with much of the existing evidence.

Conclusion The findings demonstrate that there is no benefit to be gained from this form of pre-operative education and that there is an associated increase in length of hospital stay. Future research could examine an ongoing programme of education and support, and might use alternative methods such as CD-ROM or the Internet.

Key Words: Pre-operative education, coronary artery surgery, anxiety, depression, wellbeing

f1 Correspondence: Dr C. M. Shuldham, Royal Brompton and Harefield Trust, Sydney Street, London SW3 6NP, U.K.

References

  1. Boore, J, Prescription for Recovery, London, RCN, 1978
  2. Hayward, J, Information—a prescription against pain, London, RCN, 1975
  3. Hathaway D. Effect of pre-operative instruction on post-operative outcomes: a meta-analysis. Nurs Res. 1986;35:269–275[Web of Science][Medline]
  4. Devine EC, Cook TD. Clinical and cost saving effects of psychoeductional interventions with surgical patients: a meta-analysis. Res Nurs Health. 1986;9:89–105[Web of Science][Medline]
  5. Devine EC. Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies. Patient Educ Couns. 1992;19:129–142[CrossRef][Web of Science][Medline]
  6. Devine EC, Cook TD. A meta-analytic analysis of effects of psychoeducational interventions on length of post-surgical hospital stay. Nurs Res. 1983;32:267–274[Web of Science][Medline]
  7. Lindeman CA. Patient Education. Ann Rev Nurs Res. 1988;6:29–60[Medline]
  8. Shuldham CM. Pre-operative education—a review of the research design. Int J Nurs Stud. 1999;36:179–187[CrossRef][Web of Science][Medline]
  9. Grady KL, Buckley DJ, Cisar NS, Fink NM, Ryan SD. Patient perception of cardiovascular surgical patient education. Heart Lung. 1988;17:349–355[Web of Science][Medline]
  10. Recker D. Patient perception of pre-operative cardiac surgical teaching done pre and post-admission. Crit Care Nurse. 1994;14:52–58[Abstract]
  11. Miller P, Shada EA. Pre-operative information and recovery of open heart surgery patients. Heart Lung. 1978;7:486–493[Web of Science][Medline]
  12. Christopherson B, Pfeiffer C. Varying the timing of information to alter pre-operative anxiety and post-operative recovery in cardiac surgery patients. Heart Lung. 1980;9:854–861[Web of Science][Medline]
  13. Marshall J, Penckofer S, Llewellyn J. Structured post-operative teaching and knowledge and compliance of patients who have had coronary artery bypass surgery. Heart Lung. 1986;15:76–82[Web of Science][Medline]
  14. Lepczyk N, Raleigh EH, Rowley C. Timing of pre-operative patient teaching. J Adv Nurs. 1990;15:300–306[Web of Science][Medline]
  15. Cupples SA. Effects of timing and reinforcement of pre-operative education on knowledge and recovery of patients having coronary artery graft surgery. Heart Lung. 1991;20:654–660[Web of Science][Medline]
  16. Rice VH, Mullin MH, Jarosz P. Pre-admission self-instruction effect on post-admission and post-operative indicators in CABG patients: partial replication and extension. Res Nurs Health. 1992;15:253–259[Web of Science][Medline]
  17. Shuldham CM. Pre-operative education for the patient having coronary artery bypass surgery. Patient Educ Couns. 2001;43:129–137[CrossRef][Web of Science][Medline]
  18. Arthur HM, Daniels C, McKelvie R, Hirsh J, Rush B. Effect of a pre-operative intervention on pre-operative and post-operative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery—A randomized controlled trial. Ann Intern Med. 2000;133:253–262[Abstract/Free Full Text]
  19. Shuldham CM, Cunningham G, Hiscock M, Luscombe P. Assessment of anxiety in hospital patients. J Adv Nurs. 1995;22:87–93[CrossRef][Web of Science][Medline]
  20. Ware JE, Sherbourne CD. MOS 36 item Short Form Health Survey (SF36) 1. Med Care. 1992;30:473–483[Web of Science][Medline]
  21. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361–370[Web of Science][Medline]
  22. Cox, T, Gotts, G, The General Well-Being Questionnaire (GWBQ Manual), Nottingham, UK, University of Nottingham, 1987
  23. Nelson S. Pre-admission clinics for thoracic patients. Nursing Times. 1995;91:29–32[Medline]
  24. Nelson S. Pre-admission education for patients undergoing cardiac surgery. Br J Nurs. 1996;5:335–340[Medline]
  25. Johnson, K, Pre-Surgery Preparation Day: 1997 Report, London, Royal Brompton Hospital, 1998
  26. Ware, JE, Snow, KK, Kosinski, MD, Gandek, MS, SF-36 health survey: manual and interpretation guide, Boston, Medical Outcomes Trust, 1993
  27. Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation. 1989;79:1.3–1.12
  28. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE 11: A severity of disease classification system. Crit Care Med. 1985;13:818–829[Web of Science][Medline]

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Does pre-operative education of patients improve outcomes? The impact of pre-operative education on recovery following coronary artery bypass surgery: a randomized controlled clinical trial
Eur. Heart J., April 2, 2002; 23(8): 600 - 601.
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