Effectiveness and Implementation Barriers of Preoperative Education on Surgical Patient Outcomes: A Scoping Review
DOI:
https://doi.org/10.55018/janh.v8i2.653Keywords:
Preoperative Education, Patient Outcomes, Perioperative care, Anxiety, Surgical Procedures, OperativeAbstract
Background: Preoperative education improves patients’ understanding and reduces anxiety before surgery. However, evidence regarding its effectiveness and contextual factors remains inconsistent and fragmented. Therefore, this scoping review aims to map the effectiveness and limitations of preoperative education on surgical patient outcomes.
Methods: This study used a scoping review design based on PRISMA-ScR, the PCC (Population, Concept, Context) framework, and the Arksey & O’Malley method. A systematic search was conducted in four databases (Scopus, SpringerLink, PubMed, ScienceDirect) for articles published between 2022 and 2026. The study selection process included duplicate removal, title and abstract screening, and full-text review based on predefined eligibility criteria. Data were extracted using a standardised charting form by independent reviewers, with discrepancies resolved through discussion. The extracted data were analysed using thematic synthesis to identify key themes related to effectiveness and implementation barriers.
Results: A total of 514 records were identified from four databases. After excluding articles that were not full-text, not open access, or not written in English (n=207), 307 articles remained for screening. During the screening stage, 263 records were excluded due to duplicate removal, irrelevant titles and abstracts, inappropriate population, intervention, or study type. A total of 44 full-text articles were assessed for eligibility, of which 24 were excluded for not explicitly addressing preoperative education as the primary focus. No studies were excluded based on quality assessment. Finally, 20 studies were included in the review. Three main themes emerged from the synthesis: (1) Cognitive and psychological effectiveness, where most studies reported improvements in patient knowledge and reduced anxiety, although some studies found limited or non-significant effects; (2) Clinical and health system outcomes, including pain reduction, reduced opioid use, postoperative recovery metrics, patient satisfaction, and healthcare service efficiency, although findings varied across contexts and populations; and (3) Implementation barriers and limitations, including variability in educational delivery, timing, digital technology effectiveness, patient characteristics, and methodological constraints. Overall, substantial heterogeneity in effectiveness was observed, along with gaps in integrating multidimensional outcomes and standardizing educational approaches.
Conclusion: Preoperative education is a beneficial intervention that can improve clinical outcomes and healthcare efficiency, although its effects vary across populations and settings. These findings support the need for standardized, context-adaptive educational protocols and further high-quality studies to evaluate their effectiveness
Downloads
References
Abbasnia, F., Aghebati, N., Miri, H. H., & Etezadpour, M. (2023). Pain Management Nursing Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy. Pain Management Nursing, 24(3), 280–288. https://doi.org/10.1016/j.pmn.2022.12.006
Alsolami, F. J. (2025). Nurse-Led Preoperative Education for Elective Surgery : Patient Satisfaction and Recall in a Mixed-Method Study. Healthcare, 13(22), 2951. https://doi.org/10.3390/healthcare13222951
Arksey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616
Arslan, E., & Özkan, S. (2025). Effects of Preoperative Mobilization Education Using the Teach- Back Method on Patient Outcomes After Gynecological Surgery : A Randomized – Controlled Study. Nursing & Health Sciences RESEARCH, 27(2), e70151. https://doi.org/10.1111/nhs.70151
Aydal, P., Uslu, Y., & Ulus, B. (2023). The Effect of Preoperative Nursing Visit on Anxiety and Pain Level of Patients After Surgery. Journal of Perianesthesia Nursing, 38(1), 96–101. https://doi.org/10.1016/j.jopan.2022.05.086
Bang, Y. J., Kim, S., Kim, J. K., Kim, H., Kim, S., Chung, C. S., Yoo, S. Y., Jeong, H., Park, B., & Lee, S. H. (2023). Effect of preoperative patient education and simulated mouth breathing training on opioid requirements in the post-anesthesia care unit after nasal surgery : a randomized controlled study. BMC Anesthesiology, 23(1), 348. https://doi.org/10.1186/s12871-023-02310-x
Call, C. M., Walsh, Z. A., Jeselskis, D., Mountjoy, R. J., Mcgrory, B. J., & Rana, A. J. (2025). Arthroplasty Today Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty : One Institution ’ s Experience. Arthroplasty Today, 35, 101870. https://doi.org/10.1016/j.artd.2025.101870
Dawod, M. S., Alswerki, M. N., Al, S. M., Keilani, D. Z., Keilani, L. Z., Alani, M. A., Saimeh, T. H., Al-tamimi, S., Al-shibly, S. M., Saimeh, Z. H., Al-juboori, M. A., Alelaumi, A., Alsheikh, F. T., Kamal, T. W., & Khanfar, A. (2024). Optimizing Recovery After Carpal Tunnel Syndrome Release Surgery : The Role of Counseling in Pain Management and Perioperative Functional Enhancement. Journal of Multidisciplinary Healthcare, 17, 971–980. https://doi.org/10.2147/JMDH.S451008
Edelmann, L., Hempel, M., Podsiadlo, N., Schweizer, N., Tong, C., Galvain, T., Taylor, H., & Schüler, M. (2022). Reduced Length of Stay Following Patient Pathway Optimization for Primary Hip and Knee Arthroplasty at a Swiss Hospital. ClinicoEconomics and Outcomes Research, 14, 105–117. https://doi.org/10.2147/CEOR.S348475
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Court, C. A., Uk, F., Hinder, S., Fahy, N., Procter, R., & Greenhalgh, T. (2017). Beyond Adoption : A New Framework for Theorizing and Evaluating Nonadoption , Abandonment , and Challenges to the Scale-Up , Spread , and Sustainability of Health and Care Technologies Corresponding Author : Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775
Güzel, N., Yava, A., & Koyuncu, A. (2024). The Effects of Preoperative Video-Assisted Education on Anxiety and Comfort After Breast Cancer Surgery_ Nonrandomized Controlled Study. Journal of PeriAnesthesia Nursing, 39(6), 999–1005. https://doi.org/10.1016/j.jopan.2024.01.017
Heard, J., Murdock, P., Malo, J., Lim, J., & Mukharjee, S. (2025). Enhanced Preoperative Pancreatoduodenectomy Patient Education Using Mixed Reality Technology : A Randomized Controlled Pilot Study. Informatics, 12(2), 42. https://doi.org/10.3390/informatics12020042
Heuvel, S. F. Van Den, Jonker, P., Hoeks, S. E., Ismail, S. Y., Stolker, R. J., & Korstanje, J. H. (2025). The effect of stand-alone and additional preoperative video education on patients ’ knowledge of anaesthesia A randomised controlled trial. European Journal of Anaesthesiology | EJA, 42(4), 313–323. https://doi.org/10.1097/EJA.0000000000002109
Kosucu, S., & Selimen, D. (2022). Effects of Music and Preoperative Education on Coronary Artery Bypass Graft Surgery Patients ’ Anxiety. Journal of Perianesthesia Nursing, 37, 807–814. https://doi.org/10.1016/j.jopan.2021.12.002
Liang, Y., Wang, P., Zhao, H., Li, B., Zhao, J., Sun, H., Wang, L., & Xing, F. (2025). Impact of a constructivist anesthesia education model on preoperative anxiety and perioperative outcomes in laparoscopic cholecystectomy. Frontiers in Medicine, 12, 1633718. https://doi.org/10.3389/fmed.2025.1633718
Mathari, S., Kuitert, L., Boulidam, N., Shehadeh, S., Klautz, R. J. M., Wijngaarden, R. D. L. Van, & Kluin, J. (2024). Evaluating Virtual Reality Patient Education in Cardiac Surgery : Impact on Preoperative Anxiety and Postoperative Patient Satisfaction. Journal of Clinical Medicine, 13(21), 6567. https://doi.org/10.3390/jcm13216567
Nilsen, P. (2015). Making sense of implementation theories , models and frameworks. Implementation Science, 10(1), 53. https://doi.org/10.1186/s13012-015-0242-0
Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., Mcinerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167
Pollock, D., Peters, M. D. J., Khalil, H., Mcinerney, P., Alexander, L., Tricco, A. C., Evans, C., Godfrey, C. M., Pieper, D., Saran, A., Stern, C., & Munn, Z. (2023). presentation of results in scoping reviews. JBI Evidence Synthesis, 21(3), 520–532. https://doi.org/10.11124/JBIES-22-00123
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for Implementation Research : Conceptual Distinctions , Measurement Challenges , and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7
Richardson, S., Lawrence, K., Schoenthaler, A. M., & Mann, D. (2022). A framework for digital health equity. NPJ Digital Medicine, 5(1), 119. https://doi.org/10.1038/s41746-022-00663-0
Sadeghi, N., Salari, N., & Jalali, R. (2025). Effect of multimedia education on anxiety and pain in patients undergoing laparoscopic cholecystectomy : a Solomon four- group randomized controlled trial. Scientific Reports, 15(1), 9357. https://doi.org/10.1038/s41598-024-77207-x 1
Schmid, M. E., Stumm, J., Stock, S., & Girdauskas, E. (2024). Patient perspectives on health care models in cardiac surgery : a qualitative evaluation. BMC Health Services Research, 24, 1309. https://doi.org/10.1186/s12913-024-11791-6
Sinderovsky, A., Grosman-rimon, L., Atrash, M., Nakhoul, A., Saadi, H., Rimon, J., Birati, E. Y., Carasso, S., & Kachel, E. (2023). Pain Management Nursing The Effects of Preoperative Pain Education on Pain Severity in Cardiac Surgery Patients : A Pilot Randomized Control Trial. Pain Management Nursing, 24(4), e18–e25. https://doi.org/10.1016/j.pmn.2023.02.003
Tricco, A. C., Lillie, E., Zarin, W., Brien, K. K. O., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Ma, Q., Horsley, T., Weeks, L., Hartling, L., Aldcroft, A., Hons, B. A., Wilson, M. G., & Garritty, C. (2018). R ESEARCH AND R EPORTING M ETHODS PRISMA Extension for Scoping Reviews ( PRISMA-ScR ): Checklist and Explanation. August 2016. https://doi.org/10.7326/M18-0850
World Health Organization [WHO]. (2021). Global strategy on digital health 2020–2025. World Health Organization.
Xing, J., Gong, C., Wu, B., Li, Y., Liu, L., Yang, P., Wang, T., Hei, Z., Zhou, S., & Chen, C. (2023). Heliyon Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery. Heliyon, 9(10), e20536. https://doi.org/10.1016/j.heliyon.2023.e20536
Zhang, H., Wang, X., Luo, H., & Zeng, W. (2025). Comparison of preoperative education by artificial intelligence versus traditional physicians in perioperative management of urolithiasis surgery : a prospective single-blind randomized controlled trial conducted in. Frontiers in Medicine, 12, 1543630. https://doi.org/10.3389/fmed.2025.1543630
Zhou, B., & Hu, Z. (2025). The Effect of Music Combined With Preoperative Education on Perioperative Anxiety in Patients Undergoing Open Cardiac Surgery : A Randomized Controlled Trial. Journal of PeriAnesthesia Nursing, 40(4), 925–929. https://doi.org/10.1016/j.jopan.2024.10.004
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kartika Nurif Adeline Putri, Rondhianto Rondhianto, Ahmad Rifai
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
