Reference: Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LMT, Unsworth M, Osmer C, Johnston M. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;(5):CD008646. doi:10.1002/14651858.CD008646.pub2
Rationale: Psychological preparation for surgery has been shown to improve negative emotions, pain, pain medication use, and length of hospital stay. Research and reviewing methods have improved since the last systematic review of these effects on surgical patients undergoing general anesthesia in 1993.6
Objective: The authors conducted a systematic review of the effects on postoperative outcomes of psychological preparation of adult patients planning to undergo elective surgery under general anesthesia.
Methods: Using methods from the Cochrane Handbook for Systematic Reviews of Interventions, the authors searched the Cochrane Register of Controlled Trials, Web of Science, MEDLINE, PsycINFO, EMBASE, and CINAHL electronic databases from inception through May 2014 for terms related to all types of elective surgeries with general anesthesia combined with synonyms for each form of psychological or mindful therapy previously described. The RCTs were included if they measured at least 2 primary and 2 secondary outcomes on adults receiving at least 1 form of psychological intervention prior to operation compared with similar adults not receiving the same psychological intervention. Primary outcomes included standardized pain following operation or behavioral measures of capacity to perform activities of daily living. Secondary outcomes were postoperative standardized measures of negative emotions including anxiety, fear, and/or depression and length of hospital stay in days. Non-RCTs or RCTs comparing differing delivery formats for the same intervention or partial interventions were excluded as were those on patient samples with clinically diagnosed psychological morbidity. Studies including individual patients with such disorders were not excluded.
Results: Among 6781 records returned by the searches, 105 RCTs qualified for summary and/or analyses. A total of 61 reported pain outcomes, 14 reported behavioral recovery, 58 reported length of hospital stay, and 50 reported negative emotion measures. Evidence was generally of low to very low quality, owing to heterogeneity of results. Meta-analysis, appropriate for 38 of the pain RCTs using standardized scores, revealed substantial pain reduction after surgery resulting from patient preparation prior to operation using all psychological interventions except behavioral ones (P = .007). Effects on functional activities of daily living (behavioral recovery) were too heterogeneous to qualify for meta-analysis, but these functions generally improved in response to psychological preparation of patients before surgery (P < .05). Length of stay was shorter for those who received psychological preparation prior to surgery in the 36 RCTs qualifying for meta-analysis (P = .007), but the results were heterogeneous, suggesting caution in interpreting this evidence. Among 31 RCTs meta-analyzed, anxiety, distress, and depression were consistently reduced by preoperative psychological interventions (P = .003). This result was mainly driven by interventions preparing patients with procedural or sensory information, relaxation techniques, or hypnosis, with no clear effect of behavioral instruction, cognitive, or emotion-focused interventions.
Authors’ Conclusions: Low-quality evidence indicates that psychological preparation may improve postoperative pain, behavioral outcomes, anxiety or distress, and length of hospital stay. Such interventions are unlikely to harm patients.