A Study to Assess the Impact of Preoperative Education on Anxiety and Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery

Surgical interventions, particularly major abdominal surgeries, are associated with significant physical and psychological stress. Among these, preoperative anxiety is one of the most common psychological responses experienced by patients. This anxiety, which may arise due to fear of the unknown, anesthesia, pain, possible complications, or even death, can adversely affect perioperative outcomes. Multiple studies have established that preoperative anxiety is linked to increased postoperative pain, delayed wound healing, prolonged hospital stay, higher analgesic requirements, and reduced patient satisfaction (Guo et al., 2012). According to Caumo et al. (2001), approximately 60%–80% of patients undergoing major surgery experience moderate to severe levels of preoperative anxiety. Moreover, anxiety-related sympathetic activation can lead to hemodynamic instability during and after surgery, compromising recovery. Preoperative education, which includes information about the surgical procedure, anesthesia, postoperative expectations, and recovery process, is considered an effective strategy to reduce preoperative anxiety. It empowers patients by enhancing their knowledge, correcting misconceptions, and fostering realistic expectations, thereby reducing fear and promoting cooperation. Evidence from various randomized controlled trials suggests that preoperative education significantly lowers anxiety levels, improves pain management, decreases postoperative complications, and shortens the length of hospital stay (Johns Hopkins Medicine, 2020; Devine, 1992). Yet, in many clinical settings, especially in resource-limited or busy hospital environments, structured preoperative education is often overlooked or inadequately provided.

Need of the study:

Given the high prevalence of preoperative anxiety and its negative impact on surgical outcomes, there is a crucial need to explore and implement non-pharmacological interventions that can improve patient care and safety. Major abdominal surgeries often require extensive recovery time, and anxiety can further complicate this process, leading to poor surgical outcomes and increased healthcare costs. In India, where the healthcare system is burdened with a high volume of surgical cases and often limited time for individualized patient education, standardized preoperative counseling is rarely practiced.

Maheshwari et al. (2016) studied preoperative anxiety in Indian surgical patients and found that 70% experienced moderate to severe anxiety prior to surgery. The anxiety was significantly associated with postoperative pain and delayed mobilization. The authors emphasized the importance of addressing psychological preparedness to improve surgical outcomes.

Johns Hopkins Medicine (2020) emphasized the use of multidisciplinary preoperative education clinics. Their internal data showed a 30% reduction in anxiety levels, 25% decrease in pain scores, and improved discharge outcomes.

Verma et al. (2017) conducted a cross-sectional study in a government hospital in India and found that only 20% of surgical patients received any form of structured preoperative education. Majority relied on verbal assurances, leading to inadequate preparation and increased anxiety. The authors recommended that structured protocols be integrated into nursing practice.

Chinnasamy et al. (2018) implemented a structured preoperative education module in a tertiary hospital in South India. Their findings showed significant improvements in patients’ knowledge, reduced anxiety levels, and early mobilization postoperatively

Furthermore, the World Health Organization (WHO) and the American Society of Anesthesiologists (ASA) emphasize the importance of addressing patients’ psychological needs as part of holistic perioperative care. A structured preoperative educational program not only benefits the patients psychologically but also enhances clinical efficiency, reduces medication dependency, and supports early mobilization post-surgery. Despite the high prevalence of preoperative anxiety among patients undergoing major abdominal surgery and its known negative impact on postoperative outcomes, structured preoperative education is not routinely provided in many clinical settings. There is a lack of consistent implementation of evidence-based, non-pharmacological interventions to reduce anxiety and improve surgical recovery. Therefore, this study seeks to assess the impact of structured preoperative education on preoperative anxiety and postoperative outcomes in patients undergoing major abdominal surgery.

OBJECTIVES:

The objectives of the study were to;

1. assess the preoperative anxiety levels among patients undergoing major abdominal surgery.
2. evaluate the effectiveness of structured preoperative education in reducing postoperative anxiety among patients undergoing major abdominal surgery.
3. assess the impact of structured preoperative education on postoperative outcomes such as pain level, mobilization, complications, and length of hospital stay between patients who received preoperative education and those who did not.
4. determine the association between preoperative anxiety levels and selected demographic variables among patients undergoing major abdominal surgery.

METHODOLOGY:

Research Approach: Quantitative, Evaluative approach

Research Design: Time series quasi experimental study design

Setting of the study: New Civil Hospital, Surat with a surgical unit performing major abdominal surgeries

Population: All adult patients (aged 18–65 years) scheduled for elective major abdominal surgery.

Sample Size: Based on a power analysis, approximately 60 patients (30 in each group) to detect a moderate effect size with 80% power and 5% level of significance.

Sampling Technique: Convenient Sampling Technique

Inclusion Criteria:

• Patients scheduled for elective major abdominal surgery.
• Patients aged 18 to 65 years.
• Patients who can understand the language of instruction.
• Patients who provide informed consent.

Exclusion Criteria:

• Emergency surgical cases.
• Patients with diagnosed psychiatric illnesses.
• Patients with hearing, visual, or cognitive impairments affecting communication.
• Patients undergoing minor or laparoscopic surgeries.

Data Collection tools:

Tool 1: Demographic profile and clinical data sheet

Tool 2: Postoperative Quality of Recovery Scale (PQRS)

Tool 3: Hamilton Anxiety Rating Scale

Ethical Considerations:

• Approval from Institutional Ethical Committee.
• Informed written consent from all participants.
• Confidentiality and anonymity ensured.
• Participant free to withdraw at any stage

RESULTS AND DISCUSSION:

TABLE 4.1: Frequency and Percentage wise distribution of Samples based on Demographic Data.

Table 4.5: Comparison of the Level of Anxiety in Experimental and control Group Before surgery and After Surgery.

Table 4.9: Distribution of Subjects According to Level of Pain on 1st and 3rd Post-Op Day

Comparison of Mean, Standard deviation T value And P value with their percentage of Physiological parameters according to Experimental Group and Control group post test Day 1 and Day 3

• Memory testing: Statistically, on Post Day 1, the control group demonstrated a marginally higher mean score (M = 1.33, SD ≈ constant) compared to the experimental group (M = 1.07, SD ≈ constant). By Post Day 3, both groups exhibited a reduction in mean scores; however, the experimental group reported a lower mean (M = 0.87) than the control group (M = 1.03), indicating a greater improvement in memory performance. The standard deviations remained relatively stable across groups and time points, suggesting homogeneity of variance. These results suggest a statistically observable trend toward enhanced memory outcomes in the experimental group by Day 3, supporting the potential efficacy of the intervention.
• Level of Attention testing: Statistically, the experimental group exhibited a greater reduction in mean scores from Post Day 1 (M = 1.07) to Post Day 3 (M = 0.87), suggesting a notable improvement in attention assuming lower scores reflect better outcomes. In contrast, the control group showed a smaller decrease in mean scores from Day 1 (M = 1.33) to Day 3 (M = 1.03). This greater change in the experimental group indicates a potentially more effective intervention, with the consistent standard deviations across groups supporting the reliability of this observed difference.

On both Postoperative Day 1 and Day 3, the experimental group exhibited lower mean ADL scores compared to the control group, suggesting improved recovery in functional status (assuming lower scores indicate better performance). The control group maintained a consistent mean ADL score of 7.5 across both time points, whereas the experimental group demonstrated a slight decrease in mean ADL score from Day 1 to Day 3, indicating progressive improvement. Additionally, the standard deviation was higher in the control group, reflecting greater variability in ADL performance among participants, while the experimental group showed more consistent outcomes.

P-Value Analysis:

• Postoperative Day 1: p = 6.49 × 10?¹?
• Postoperative Day 3: p = 1.21 × 10??

Both p-values are well below the conventional significance threshold of 0.05, indicating statistically significant differences in ADL scores between the control and experimental groups at both time points.

Conclusion:

These findings provide strong statistical evidence that the preoperative education intervention had a significant positive impact on postoperative recovery in terms of Activity of Daily Living (ADL) performance among patients undergoing major abdominal surgery. The experimental group exhibited a meaningful reduction in anxiety levels from Postoperative Day 1 (M = 14.77) to Day 3 (M = 12.13), indicating a positive trend toward reduced psychological distress. In contrast, the control group showed minimal improvement, with anxiety scores decreasing slightly from 21.13 to 20.3, reflecting persistently elevated anxiety levels.

T-Value and P-Value Interpretation:

The greater t-value and significantly lower p-value observed on Postoperative Day 3 further support the conclusion that the reduction in anxiety within the experimental group was statistically significant (p < 0.05), and unlikely to be due to random variation. This suggests that the impact of the intervention became more pronounced over time.

Conclusion:

These findings indicate that the intervention had a statistically significant effect in reducing anxiety levels among patients in the experimental group, particularly by Day 3, highlighting its potential efficacy in improving psychological recovery following surgery.

Comparison of the Total Recovery Score in Control Group and Experimental

Group in Post Day 1 and Post Day 3