Experts reach consensus on preop education to support surgical recovery

Editor's Note

A new international consensus offers the first multidisciplinary definition and set of recommendations for group-based preoperative education programs, sometimes referred to as “surgery schools.” Published June 21 in the British journal Anaesthesia, the expert-driven guidance aims to improve patient preparation, experience, and recovery for those undergoing major elective surgery while standardizing program design and content across healthcare systems.

Led by the Perioperative Quality Initiative (POQI), the consensus process engaged 32 clinicians and researchers from five countries across four virtual workshops. Using a modified Delphi method, the group reviewed existing evidence and expert practice to craft a working definition and finalize 18 recommendations and three outcome statements with at least 85% agreement. The process also incorporated feedback from patient representatives. Key takeaways of the guidance include:

• Surgery school (a term common in the UK) is defined as an interactive, group-based education and behavior change intervention delivered by clinicians to patients and their support networks before major surgery, with the goal of empowering patients and improving recovery.
• Evidence supporting satisfaction and experience is rated high-certainty. A systematic review cited in the consensus found a 0.70-day reduction in mean hospital stay (95% CI: 0.27–1.13) across orthopedic studies as well as lower odds of postoperative complications (OR 0.56; 95% CI: 0.36–0.85) in mixed-specialty surgeries.
• Patient-centered outcomes with moderate-certainty evidence include improved physical function, reduced anxiety and pain, greater preparedness, and better quality of life.

All patients undergoing major elective surgery should be offered surgery school, including for procedures typically requiring an overnight hospital stay. Multidisciplinary teams should design and deliver live, interactive sessions supported by take-home materials, with core topics including chronic condition management, physical activity, nutrition, pain control, and more. Content should incorporate behavior change techniques and strategies to increase patient self-efficacy.

Although high-quality trials remain limited, surgery schools are increasingly used worldwide, researchers write. The group identified 17 priorities for future research, including cost-effectiveness, long-term behavior change, and the role of digital delivery.