The importance of patient education before surgery

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

For years, research and common belief have supported the concept that patient education alters patient behavior and improves patient outcomes. For instance, lifestyle changes, implemented after improved physician-patient engagement and education, have demonstrated clinical benefits in a wide range of chronic illnesses, such as cardiovascular disease, diabetes, and arthritis. Patient education can be advanced through many avenues before, during, or after a procedure. Some strategies include scheduling a visit in a preoperative evaluation clinic (PEC), having a thorough discussion of a patient’s medical history, implementing enhanced recovery after surgery (ERAS) programs, holding an extensive preoperative conversation on anesthetic options, and expanding patient knowledge on neuraxial anesthesia prior to labor and delivery.

Traditionally, the first time a physician anesthesiologist interacts with a patient is on the day of surgery, especially for minor outpatient procedures. For healthy patients, such a short period of physician-patient interaction is typically not an issue. However, in the United States, an estimated 48 million outpatient surgeries occurred in hospitals and ambulatory surgery centers in 2010, with approximately 35 percent of all patients having an ASA Physical Status III or greater, indicating patients with more severe preoperative disease processes. These patients may benefit from increased communication and evaluation from their physician anesthesiologist.

Over the past few decades, there has been an increasing trend to schedule more complex patients for an assessment by a physician anesthesiologist in a PEC. There are many benefits to a well-established PEC, including reduced mortality, surgical cancellations, unnecessary testing, and patient anxiety, as well as, increased patient and physician satisfaction and improved patient compliance with preoperative instructions. In a PEC, a patient can be fully informed in a less stressful environment, days or weeks before an elective surgery.

Additionally, a thorough discussion about a patient’s past medical history and medications (prescribed or otherwise) is important. An estimated 44 percent of patients take a daily herbal supplement, with 16.5 percent taking a supplement that could interact with anesthetics or other medications received during the perioperative period. A preoperative dialogue can help ensure the physician anesthesiologist provides necessary instruction to the patient to avoid potentially unsafe medication interactions.

During perioperative care, ERAS programs utilize patient education as an important aspect of achieving improved patient satisfaction, shorter hospital stays, reduced readmission rates, and fewer complications. Daily, patients undergo elective surgeries like hysterectomies (removal of the uterus), cystectomies (removal of the bladder), laparoscopic sleeve gastrectomies (partial removal of the stomach for weight loss), partial hepatectomies (partial removal of the liver) and colorectal procedures (partial removal of part of the intestines). ERAS is a treatment pathway for these patients designed to reduce the stress response to surgery. The pathway incorporates preoperative instructions and counseling, chronic disease optimization, preoperative nutrition, standardized anesthetic and analgesic techniques, early mobilization and gut feeding (orally or through a tube). Patient education thus improves compliance with preoperative instructions.

Studies show preoperative discussions about anesthesia for joint replacement procedures have significant benefits, as well. The type of anesthetic a patient receives can influence their outcome, so an early discussion of anesthetic choices may allow patients to ask appropriate questions and learn their options. For instance, neuraxial anesthesia, such as spinal anesthesia, is associated with better outcomes and patient satisfaction when used in joint replacement cases, including a 30 to 50 percent reduction in mortality. A recent study found that when patients attended an optional three-hour class about their upcoming orthopedic surgery to discuss the pros and cons of various anesthetic techniques, they were more likely to choose spinal anesthesia.

Another potential area for advancing perioperative care using patient education is in obstetric anesthesia. In 2015-2016, a study demonstrated more than 39 percent of the population is obese, categorized as a body mass index (BMI) of over 30, which is up from 30 percent in 2001-2002. Obesity comes with complications, including increased risk of diabetes, hypertension, stroke, and cardiac disease. Obesity in pregnancy is also increasingly more common.  In pregnancy, obesity can increase the risk of gestational diabetes, pre-eclampsia, and sleep apnea, as well as increase the risk of miscarriage, birth defects, high birth weight, preterm birth, and stillbirth. Furthermore, obesity increases the risk of anesthetic complications, especially involving airway compromise. A recent survey demonstrated that pregnant patients had less knowledge about obesity’s effects on pregnancy or anesthetic complications, if those patients had a BMI above 30, if they had never given birth before, or lacked college-level education.

As with utilizing patient education to mitigate chronic illness, the addition of patient education as a major part of preoperative care improves perioperative outcomes. In the high stress, fast-paced world of anesthesia care, patient awareness and knowledge is vitally important for overall success.

Steven Young and Joseph Answine are anesthesiologists.

Image credit: Shutterstock.com

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