Abstract
Background: In the United Kingdom high anaesthetic risk surgical patients (those pre-disposed to complications because of for example, pre-existing conditions), have increased chance of irreversible disability or death; accounting for 80% of perioperative mortality (Pearse, Holt and Grocott 2011). Psychological preparation for surgery under General Anaesthetic (GA) can improve postoperative outcomes in a general population (Johnstonand Vogele 1993; Powell, Scott, Manyande et al. 2016). Powell, Scott, Manyande et al. (2016) suggested benefit on postoperative pain, negative affect, length of stay (LOS) and behavioural recovery. However, psychological optimisation by Preoperative Assessment
Services remains outside usual care and to date no systematic review has been undertaken relating to high-risk GA patients. Arguably, the best indicators of postoperative recovery for
this high-risk group are behavioural recovery and quality of life (QoL).
Aims:
1. To assess whether preoperative psychological interventions are effective for improving behavioural recovery outcomes for high-risk anaesthetic patients, compared to standard care alone?
2. To assess whether preoperative psychological interventions, are effective at maintaining or improving QoL at one-month or more post-surgery compared to standard care alone?
Methods: Twelve databases were searched up to November 2017. Published Randomized Controlled Trials of adults undergoing elective surgery were included if outcomes were examined one-month to one-year postoperatively. Reference lists and forward citation searching followed. No language or date restrictions were imposed. Findings were pooled using continuous: d (hedges g) outcome type, and narrative synthesis was undertaken where meta-analysis was unsuitable. Eppi-reviewer4 software was used to manage the review (EPPI-Centre 2017).
Results: Eleven papers (n=1272) met eligibility criteria. Five were appropriate for meta-analysis; the remainder were narratively reviewed. Findings demonstrated no effect on behavioural recovery from any psychological intervention (SMD- 0.11, 95% confidence
interval (CI) -0.61-0.40). QoL was not improved by psychological interventions either (SMD0.50, 95% CI -1.69-0.69 for total QoL and SMD -1.35, 95% CI -2.95-0.25. Narrative synthesis demonstrated psychological interventions did positively influence behavioural recovery and improved mental and physical QoL was demonstrated to be statistically significant in the intervention group of two papers reviewed narritively. However, one paper
concluded that the intervention favoured the control group and therefore it is harmful. Results should be treated cautiously as there were high levels of heterogeneity for the outcome behavioural recovery. There were insufficient studies to determine the most effective intervention type.
Conclusion: Evidence suggested no improvement in behavioural recovery or QOL of high-risk anaesthetic patients when psychological interventions were delivered preoperatively.
The quality of evidence was low, and no practice recommendations can be made. There is a need for further high-quality research examining larger samples of this patient population.
| Date of Award | 2018 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Katherine Brown (Supervisor) & Alison Day (Supervisor) |