TEMPLATE DESIGN © What is the effect of preoperative education on patient outcomes after joint replacement surgery? Principal Investigator: Marge Kearney APN, ONC 1 Sub-Investigators: Mary Kay Jennrich RN, BSN 1, Stephanie Russo DPT, MSCS 1, Rochelle Robinson RN, ONC 1, Sheri Wilhelmi RN, BSN 1, Stephanie Wink RN, BSN 1, Dan Felice MPT 1, Lisa Orlet MPT 1, Barbara Berger PhD, RN 2 1 Advocate Good Samaritan Hospital, 2 University of Illinois at Chicago Abstract Findings Conclusions/Discussion AcknowledgementsAnalysis Findings (continued) Contact information The research team would like to thank the following for their support of this study: Marty Dietrich MPH, Ginger Diven MS, RN, Gail Conforti MS, RN, CGRN, Carol Rogers PhD, APRN, BC and the staff nurses and physical therapists of the Ortho/Trauma unit at Advocate Good Samaritan Hospital. Introduction: This descriptive comparative study explored the effects of preoperative education on patient outcomes after total joint replacement surgery. Methods: Subjective data were obtained from each enrolled patient through a survey about their expectations of, and experiences after, total joint replacement surgery. Objective data were identified through a retrospective chart review and a follow-up phone call 30 days after discharge. A total of 150 patients having single joint total knee or total hip replacement surgery were enrolled. Results: Findings showed some statistically significant differences between patients who attended the structured class and those who did not attend. Patients who attended the structured class felt significantly better prepared for surgery and better able to control their pain after surgery. No differences were found in postoperative pain levels, complications, ambulation distances or length of stay (LOS). Conclusions: Attending a structured preoperative class prior to total joint replacement surgery was beneficial. Purpose/Research Questions This research study compared outcomes of patients who attended a free face-to-face preoperative education class offered by the hospital with those who did not attend. Do patients who attend this class feel better prepared for surgery, have more realistic expectations regarding postoperative pain and exercises, and comply better with measures to prevent complications? Are there any significant differences in reported pain, ambulation distance, complication rate and LOS? Are there any significant differences in discharge disposition or level of confidence regarding pain control and required therapy after discharge? Background Advocate Good Samaritan Hospital offers a structured preoperative education class for patients undergoing elective total knee or total hip replacement. A staff nurse and physical therapist teach this face-to-face two hour class which covers topics such as pain control, prevention of complications, exercises and discharge planning. About 50% of eligible patients attend this class and many of the instructors feel that these patients do better postoperatively. Studying the effects of preoperative education on patient outcomes after joint replacement surgery was the basis for this descriptive comparative study. Literature review found no evidence supporting use of preoperative education over and above the standard care to improve postoperative clinical outcomes with respect to pain, functioning, complications and LOS. There was evidence that preoperative education has a modest beneficial effect on preoperative anxiety. Methods Procedures: Patients were identified on admission to the orthopaedic unit and were screened by a sub-investigator. If they met criteria, their consent was obtained, they were assigned a study ID and they were asked to complete the survey. The patient’s medical record was reviewed to obtain clinical data. Patients were called 30 days after discharge to identify any postoperative complications. Sample: A total of 150 patients were enrolled in this study. This sample size was determined by power analysis. Eligible patients were those who were having a single joint total knee or hip replacement, who had not had this type of surgery in the past 5 years, who could read and write English, were alert and oriented and were to be discharged from the orthopaedic unit. Marge Kearney APN, ONC c/o Advocate Good Samaritan Hospital 3815 Highland Avenue Downers Grove, IL OPTIOAL LOGS HERE Patients who attended the structured preoperative education class felt better prepared for surgery and better able to control their postoperative pain (Table 2). However, they did not have significantly different clinical outcomes after surgery (Table 3). Consistent with other research, this study found no significant difference in postoperative pain level, length of stay, or ambulation distance based on preoperative education. The data did show a trend toward significance for an association between either of two types of structured preoperative education and a decrease in postoperative complications (Table 4). This study validated the content of the current class for preparing patients for joint replacement surgery. However, only about half (51%) of the patients having total joint replacement attended the structured face-to-face class, many because they were unaware of it. Future plans include sharing results with surgeons to encourage them to send their patients to this structured class. TABLE 2 – PATIENT PERCEPTIONS TABLE 3 – CLINICAL OUTCOMES Complications Class attendanceYesNotest statistic p value Face-to-face (f2f) class No class X 2 1df = Structured education ( f2f or on-line ) No structured education X 2 1df = TABLE 4 – COMPLICATIONS Data were entered into a single data file and analyzed using SPSS. Following verification of data accuracy, descriptive statistics were evaluated for each variable. Distribution-free nonparametric procedures were used to test hypotheses (  =.05) related to preoperative education and joint replacement outcomes. The face-to-face (f2f) class offered by Advocate Good Samaritan Hospital is a structured course designed to help patients anticipate and prepare for surgery. Many of our participants indicated that they also obtained preoperative information from searching on-line sites, from their doctor, office staff or presurgical testing nurses, and/or from a specific on-line course. The following table compares the number of postoperative complications between those who received a structured education offering (f2f or specific on- line course) with those reporting no structured education.