Does Pre-Operative Education Reduce Length of Stay and Improve Clinical Outcomes After Elective Orthopaedic Surgery? A Systematic Review and Meta-Analysis

TL;DR

This study finds that pre-surgery education helps patients stay in the hospital less and feel more satisfied, but doesn't improve pain or function.

Contribution

First systematic review and meta-analysis on pre-operative education's impact on clinical outcomes in elective orthopaedic surgery.

Findings

Pre-operative education reduced hospital stay by 0.37 days on average.

Education improved patient satisfaction and short-term psychological scores.

No significant effect on pain, function, or quality of life was observed.

Abstract

The aim of this review was to assess whether pre-operative patient education can reduce hospital length of stay and improve clinical outcomes for adult patients undergoing elective orthopaedic operations. The study was registered on the NIHR PROSPERO database (ID: CRD42021224356) and conducted according to the PRISMA guidelines. A search of electronic databases in February 2023 found 17 studies. The quality of evidence was assessed using the GRADE approach. A meta-analysis was conducted, and the outcomes were presented as mean difference, standardised mean difference, or a risk ratio. Pre-operative patient education offered benefit with a shorter length of stay by a mean of 0.37 days (n=1,729; 95% CI: -0.65 to -0.09; p=0.01) and these results were corroborated by sensitivity analyses studying RCTs only (MD: 0.42; 95% CI 0.77 to 0.07; p=0.02) and studies deemed to be at low risk of bias (MD: 0.24; 95% CI 0.44 to 0.04; p=0.02). Pre-operative patient education also offered a benefit to patient satisfaction (SMD: 0.43; 95% CI: 0.01 to 0.84; p=0.04) and improved short-term psychological scores (SMD: -0.44; 95% CI: -0.82 to -0.06; p=0.02). It offered no benefit for pain scores, functional scores, frequency of adverse events, and quality of life, and these results failed to reach statistical significance. Pre-operative patient education is associated with a decreased length of hospital stay and improved patient satisfaction and short-term psychological scores.

Figures