Preoperative education refers to any educational intervention delivered before surgery that aims to improve people's knowledge, health behaviours and health outcomes. The content of preoperative education varies across settings, but frequently comprises discussion of presurgical procedures, the actual steps in the surgical procedure, postoperative care, potential stressful scenarios associated with surgery, potential surgical and non-surgical complications, postoperative pain management and movements to avoid post-surgery. Education is often provided by physiotherapists, nurses or members of multidisciplinary teams, including psychologists. The format of education ranges from one-to-one verbal communication, patient group sessions, or video or booklet with no verbal communication.

preoperative education is embedded in the consent process, we are unsure if it offers benefits over usual care in terms of reducing anxiety, or in surgical outcomes, such as pain, function and adverse events. Preoperative education may represent a useful adjunct, with low risk of undesirable effects, particularly in certain patients, for example people with depression, anxiety or unrealistic expectations, who may respond well to preoperative education that is stratified according to their physical, psychological and social need.

Thirteen studies were included: eight RCT’s, four cohort studies and one quasi-experimental study. All studies concerned a preoperative structured educational intervention on postoperative self-management activities of patients, such as everyday movements, coughing, getting out of bed or exercising. Safety outcomes were complications, in-hospital falls and mortality. Results from eleven studies indicate positive effects of such patient-related interventions.

Two authors (LH & HC) independently assessed inclusion eligibility of the studies by title and abstract. If there was no abstract available only the title was assessed. Differences in inclusion eligibility were solved by discussion. Full text articles were retrieved for the eligible studies. The initial agreement of the two authors on full text retrievement was 96.4%. For the final selection full text copies were examied to determine whether they fulfilled the inclusion criteria.

  The studies had to meet four inclusion criteria. First, the participants had to be surgical patients. Second, the study needed to investigate the effect of interventions regarding active involvement of patients, potentially with help of a health care professional. Third, the outcome had to be related clearly to safety and should be appropriately reported. Following the IOM definition we described safety as the prevention of harm to patients. We thus searched for safety outcomes such as adverse events, medication errors and complications. Side effects such as nausea, vomiting and difficulty to swallow were not considered to be safety related and therefore excluded. full text had to be written in English or Dutch and should be available. Studies addressing alcohol and smoking cessation programs were excluded because of the availability of systematic reviews. After evaluating the full text articles, a manual cross-reference search of eligible articles obtained for full-text evaluation was undertaken.

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