The mediating role of pre‐operative patient readiness on surgical outcomes: A structural equation model analysis

Abstract

Aims:To determine the mediating role of surgical readiness on patient characteristics (surgical risk, type of surgery, pre-operative anxiety, and health literacy) and its influence on surgical outcomes (pain, postoperative complications, and surgical experience).Design: Correlational, theory testing using structural equation modelling. Methods:A total of 376 consecutively selected surgical patients from four tertiary hospitals were recruited and followed-up 48-72 hr postoperatively from May-October 2017. Consenting respondents answered questionnaires measuring basic surgical information, health literacy, anxiety, surgical readiness, pain score, and surgical experience. Further, records review was conducted to identify occurrence of any postoperative complications and use of additional analgesics. Results:A good fit and parsimonious model (χ 2 /df = 0.75, RMSEA = 0.00, GFI = 0.99, CFI = 1.00, PNFI = 0.50) highlighted the mediating effect of pre-operative readiness between patient characteristics and surgical outcomes. The type of surgery (curative) influenced patient readiness, surgical complications, and use of additional postoperative analgesics. Higher health literacy negatively influenced patient readiness; can decrease the use of postoperative analgesics; and lessen postoperative pain. Further, pre-operative anxiety decreased patient readiness and increased postoperative pain and negatively influenced the surgical experience. Conclusion:Patient readiness is beyond the physiological aspect of pre-operative preparation and it is influenced primarily by the mental and emotional state of a patient. Addressing issues such as anxiety and health literacy can improve pre-operative readiness that can enhance pain management and surgical experience. Hence, the mediating role of readiness in improving surgical outcomes emphasizes the need to deliver a patient-centred and individualized approach to patient preparation with a key focus on their readiness for surgery. Impact:This study demonstrates the difference between preparing patients and promoting readiness for surgery. Surgical readiness requires patient-centred approach in promoting a more engaged and confident patient who is capable to use appropriate health information and how it can lead to better surgical outcomes.

Systematic Review of Preoperative Patient Readiness

“…After completing this review, we identified an opportunity for perioperative nurses to provide holistic preoperative care that is not limited to physical preparation, but includes mental and psychosocial dimensions. The nurses should consider promoting educational programs for preoperative readiness to improve the patient’s physical and psychological outcomes (eg, decreased anxiety, improved pain management), resulting in a positive surgical experience for the patient 9 …”

“…Traditionally, patient preparation focuses on implementing a preoperative bundle that includes medication administration, 5 laboratory assessments, 5 and health teaching 6 . Some experts separate readiness from preparedness, recognizing the need for physical preparation 7,8 and the importance of the mental and emotional state of a patient preparing for surgery 7,9 . Perioperative nurses promote surgical readiness through the delivery of preoperative education that can increase the patient’s knowledge and satisfaction and, in some cases, reduce anxiety in patients preparing for surgery 10 .…”

The construction of the structural equation model of burden, benefit finding, and anxiety-depression of esophageal cancer caregivers based on Lazarus stress and coping theory

“…The sample size was calculated through GPower version 3.1.9 as follows: validity of sample size was 95.1%, effect size was 0.3, and significance level was 5% (bilateral) in 134 respondents. In order to ensure the statistical stability of the structural equation model, the sample size was expanded to >200 cases (16). This study adhered to the Helsinki declaration (as revised in 2013), principles of informed consent, security protection, privacy and confidentiality, and fairness and transparency.…”

“…The total score of BFS was 80 [51-90], and the 5 dimensions were: acceptance, 11 [7][8][9][10][11][12][13]; family relationship, 21 [14][15][16][17][18][19][20][21][22][23][24]; personal growth, 27 [19][20][21][22][23][24][25][26][27][28][29][30][31]; social relationship, 10 [7][8][9][10][11][12]; and health behavior, 9 [7][8][9][10][11][12], respectively. The total score of CBI was 34 [23][24][25][26][27][28][29][30]…”

“…There were 26 (11.4%) patients with no or light burden, 128 (56.1%) with medium burden, and 74 (32.5%) with heavy burden. The total score of HADS was 18 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], among which anxiety was 9 [5][6][7][8][9][10][11][12], and depression was 8 [5][6][7][8][9][10][11][12][13]. There were 116 (50.9%) patients with anxiety, 106 (46.5%) with depression, and 107 (46.9%) with both anxiety and depression.…”