The effect of pre-operative education intervention on patient uncertainty and length of stay after coronary artery bypass graft surgery
DOI:
https://doi.org/10.26550/2209-1092.1343Keywords:
cardiac surgery, coronary artery bypass graft, educational program, length of stay, uncertaintyAbstract
Background: Coronary artery disease (CAD) remains a leading cause of global mortality. For patients whose condition is refractory to medical interventions, coronary artery bypass graft (CABG) surgery stands as the gold standard surgical treatment. Patients undergoing CABG frequently experience pre-operative uncertainty, which has been correlated with adverse post-operative outcomes. This uncertainty often stems from concerns regarding disease severity, potential life-threatening complications, the
likelihood of treatment success and effective symptom management.
Aims: This study aimed to examine the impact of a structured pre-operative education intervention program on patients undergoing CABG surgery and to evaluate post-operative health outcomes, specifically patients’ uncertainty levels and hospital length of stay.
Methods: A post-test-only control group experimental design was employed, using a convenience sample of 130 patients requiring CABG surgery. Participants were randomly assigned to either the control or the experimental group (n = 65 per group). Data were analysed using descriptive and inferential statistics.
Results: Patients who received pre-operative structured education reported significantly lower levels of uncertainty post-operatively compared to patients who received routine
pre-operative care. The difference in post-operative length of stay between the groups was not statistically significant.
Conclusions: The findings of this study highlight the importance of structured pre-operative education interventions in influencing post-operative outcomes,
particularly reducing uncertainty, for patients undergoing CABG surgery.
References
1. World Health Organization (WHO). Noncommunicable diseases (NCD) country profiles [Internet]. Geneva: WHO; 2023 [cited 2025 Jan 28]. Formerly available from: www.who.int/nmh/countries/jor-en.pdf
2. Lindstrom M, DeCleene N, Dorsey H, Fuster V, Johnson CO, LeGrand KE et al. Global burden of cardiovascular diseases and risks collaboration, 1990–2021 [Internet]. J Am Coll Cardiol. 2022;[cited 2025 Jan 7]80(25):2372–425. DOI:10.1016/j.jacc.2022.11.001
3. Baig K, Harling L, Papanikitas J, Attaran S, Ashrafian H, Casula R et al. Does coronary artery bypass grafting improve quality of life in elderly patients? [Internet]. Interact Cardiovasc Thorac Surg. 2013[cited 2025 Feb 1];17(3):542–53. DOI: 10.1093/icvts/ivt220
4. Persson J, Yan J, Angerås O, Venetsanos D, Jeppsson A, Sjögren I et al. PCI or CABG for left main coronary artery disease: The SWEDEHEART registry [Internet]. Eur Heart J. 2023[cited 2025 Jan 7];44(30):2833–42. DOI:10.1093/eurheartj/ehad369
5. Eppel-Meichlinger J, Mayer H, Steiner E, Kobleder A. From existential uncertainty to a new mindset promoting recovery: Exploring the development of uncertainty experience in women with vulvar neoplasia – a qualitative longitudinal study [Internet]. BMC Womens Health. 2024[cited 2025 Jan 7];13;24(1):35. DOI: 10.1186/s12905-024-02889-4
6. Xia BY, Yu JM, Wu XY. Illness, uncertainty and its associated factors in coronary heart disease patients with heart stent implantation: A cross-sectional study [Internet]. Ann Palliat Med. 2022[cited 2025 Jan 9];11(7):2410421–2421. DOI: 10.21037/apm-22-528
7. Mishel MH. Uncertainty in illness [Internet]. Image J Nurs Sch. 1988 [cited 2024 Dec 7];20(3):225–31. DOI: 10.1111/j.1547-5069. 1988.tb00082.x
8. Jeong H, Lee Y, Park JS, Lee Y. Influence of illness uncertainty on health behavior in individuals with coronary artery disease: A path analysis [Internet]. J Korean Acad Nurs. 2024[cited 2025 Jan 16];54(2):162–77. DOI: 10.4040/jkan.23136
9. Ebrahimi S, Tehrani TH, Azizi A, Vahedparast H, Sadeghian E. Challenges faced by cardiac patients prior to coronary artery bypass grafting: A qualitative study [Internet]. BMC Cardiovasc Disord. 2025[cited 2025 March 28];25(1):142. DOI: 10.1186/s12872-025-04577-z
10. Brodersen F, Wagner J, Uzunoglu FG, Petersen-Ewert C. Impact of preoperative patient education on postoperative recovery in abdominal surgery: A systematic review [Internet]. World J Surg. 2022[cited 2025 Jan 15];47(4):937–47. DOI: 10.1007/s00268-022-06884-4
11. Banner D. Becoming a coronary artery bypass graft surgery patient: A grounded theory study of women’s experiences [Internet]. J Clin Nurs. 2010[cited 2025 Jan 7];19(21):3123–33 .DOI: 10.1111/j.1365-2702.2010.03424.x
12. Cavallaro PM, Milch H, Savitt L, Hodin RA, Rattner DW, Berger DL et al. Addition of a scripted pre-operative patient education module to an existing ERAS pathway further reduces length of stay [Internet]. Am J Surg. 2018[cited 2025 Jan 10];216(4):652–7 DOI: 10.1016/j.amjsurg.2018.07.016
13. Fecher-Jones I, Grimmett C, Ainsworth B, Wensley F, Rossiter L, Grocott MP et al. Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery [Internet]. BJA Open. 2024[cited 2025 Jan 7];10:100286. DOI: 10.1016/j.bjao.2024.100286
14. Cyganrowicz B, Milaniak I. The effect of a preoperative education program on the quality of life and the reduction of symptoms of anxiety and depression in patients undergoing a coronary artery bypass graft surgery – a quasi-experimental study [Internet]. Nurs Probl. 2024[cited 2025 Jan 9];32(2):77–84. DOI: 10.5114/ppiel.2024.140688
15. Guo P. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: A review of randomised controlled trials. J Clin Nurs. 2015[cited 2025 Feb 7];49(2):129–37. DOI: 10.1111/jocn.12618
16. Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G. Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting [Internet]. CMAJ. 2001[cited 2025 Feb 7];165(4):429–33. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC81367/
17. Snowdon D, Haines TP, Skinner EH. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: A systematic review [Internet]. J Physiother. 2014[cited 2025 Jan 17];60(2):66–77. DOI: 10.1016/j.jphys.2014.04.002
18. Cohen J. A power primer [Internet]. Psychol Bull. 1992[cited 2025 Jan 17];112(1):155–9. DOI: 10.1037/0033-2909.112.1.155
19. Mishel MH. Uncertainty in chronic illness [Internet]. Annu Rev Nurs Res. 1999[cited 2024 Dec 7];17(1):269–94. Available from: https://connect.springerpub.com/content/sgrarnr/17/1/269
20. Etkind SN, Bristowe K, Bailey K, Selman LE, Murtagh FE. How does uncertainty shape patient experience in advanced illness? A secondary analysis of qualitative data [Internet]. Palliat Med. 2017cited 2025 Jan 7];31(2):171–80. DOI: 10.1177/0269216316647610
21. Ryu K, Cho SH. The effects of visual information on anxiety, uncertainty and nursing satisfaction in elderly patients after the total knee arthroplasty [Internet]. Journal of muscle and joint health. 2015[cited 2025 Jan 29];22(1):48–56. DOI: 10.5953/JMJH.2015.22.1.48
22. Shin EJ, Lee YS. The effect of nursing information on anxiety and uncertainty in patients for endoscopic submucosal dissection before the procedure [Internet]. J Korea Acad Ind Coop Soc. 2016[cited 2025 Jan 29];17(2):66–74. DOI: 10.5762/KAIS.2016.17.2.66
23. Chuang MF, Tung HH, Clinciu DL, Huang JS, Iqbal U, Chang CJ et al. The effect of an integrated education model on anxiety and uncertainty in patients undergoing cervical disc herniation surgery [Internet]. Comput Methods Programs Biomed. 2016[cited 2025 Jan 10];133:17–23. DOI: 10.1016/j.cmpb.2016.05.003
24. Jeon S, Park H. Effect of preoperative education using multimedia on pain, uncertainty anxiety and depression in hysterectomy patients [Internet]. Korean J Women Health Nurs. 2016[cited 2025 Jan 12];22(1):39–47.DOI: 10.4069/kjwhn.2016.22.1.39
25. Bashyal K, Baral RK, Khakural P, Kadel PB, Gurung A, Bhattarai A. Predicting length of hospital stay following adult cardiac surgery: A prospective observational study [Internet]. MedS Alliance J Med Med Sci. 2023[cited 2025 Jan 7]30;3(6):4–11. DOI: 10.3126/mjmms.v3i6.66538
26. Ramesh C, Nayak BS, Pai VB, Patil NT, George A, George LS et al. Effect of preoperative education on postoperative outcomes among patients undergoing cardiac surgery: A systematic review and meta-analysis [Internet]. J Perianesth Nurs. 2017[cited 2025 Jan 7];32(6):518–29. DOI: 10.1016/j.jopan.2016.11.011
27. Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C, Brokalaki H. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? [Internet]. Eur J Cardiovasc Nurs. 2016[cited 2025 Jan 7];15(6):447–58. DOI: 10.1177/1474515115602678
28. Sorensen EA, Wang F. Social support, depression, functional status, and gender differences in older adults undergoing first-time coronary artery bypass graft surgery [Internet]. Heart Lung. 2009[cited 2025 Jan 12];38(4):306–17. DOI: 10.1016/j.hrtlng.2008.10.009
29. Aburuz ME, Dahger N, Al-Akash HY, Momani A, Ahmed FR. Perceived control and length of stay coronary artery bypass graft surgery [Internet]. Nurs Pract Today. 2021[cited 2025 Jan 16];9(2):170–8. DOI: 10.18502/npt.v9i2.8899
30. Biondi F, Aprosoff J, Dowell G, Taylor T, Yoon S, Kertsman E et al. Identifying selected mental health, physical, and social determinants of extended length of stay after elective cardiac surgery [Internet]. J Cardiovasc Nurs. 2024[cited 2025 Jan 7] (advance online publication). DOI: 10.1097/JCN.0000000000001217.
31. Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery [Internet]. BMC Health Serv Res. 2015[cited 2025 Jan 27];16:318. DOI: 10.1186/s12913-016-1591-3
32. Jafarkhani A, Imani B, Saeedi S, Shams A. Predictive factors of length of stay in intensive care unit after coronary artery bypass graft surgery based on machine learning methods [Internet]. Arch Acad Emerg Med. 2025[cited 2025 Mar 25 ];13(1):e35. DOI: 10.22037/aaemj.v13i1.2595
33. Triana AJ, Vyas R, Shah AS, Tiwari V. Predicting length of stay of coronary artery bypass grafting patients using machine learning[Internet]. J Surg Res. 2021[cited 2025 Mar 7];1:264:68–75. DOI: 10.1016/j.jss.2021.02.003
34. Ai AL, Wink P, Shearer M. Secular reverence predicts shorter hospital length of stay among middle-aged and older patients following open-heart surgery [Internet]. J Behav Med. 2011[cited 2025 Mar 8];34(6):532–41. DOI: 10.1007/s10865-011-9334-8
35. Cserép Z, Losoncz E, Tóth R, Tóth A, Juhász B, Balog P et al. Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery [Internet]. BMC Cardiovasc Disord. 2014[cited 2025 Jan 7];14(1): 171. DOI: 10.1186/1471-2261-14-171
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Copyright (c) 2025 Khulood Sh, Batarseh, Manar Nabolsi, Mohammad YN Saleh , Haifa SY Batarseh
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