Pre-operative psychological interventions’ impact on post-surgical pain, affect and hospital stay: systematic review and meta-analysis

Abstract

Background: Psychological preparation for surgery was found to improve post-operative outcomes in a 1993 meta-analysis. Since then, many more studies have been completed and hospital procedures have developed. The present study aimed to examine research evaluating the impact of pre-operative psychological interventions on post-surgical pain, negative affect and hospital stay length. Methods: This was a systematic review and meta-analysis conducted using Cochrane methodology. Seven electronic databases were searched: CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Dissertation Abstracts and Web of Science. Included studies were randomised controlled trials of adults undergoing elective surgery under general anaesthesia. Trials evaluated pre-operative psychological interventions: procedural information; sensory information; behavioural instruction; cognitive interventions; relaxation; hypnosis; emotion-focused interventions. Outcomes were post-surgical pain, negative affect and hospital stay length. Random effects meta-analyses were conducted to combine data across studies for each outcome. Findings: Searches identified 5116 papers from which 105 studies were included. Studies measured the outcomes pain (61 studies), negative affect (49), and hospital stay (58). Data were available for meta-analysis in 38 (pain), 31 (negative affect) and 36 (hospital stay) studies. When considering any type of intervention, there was evidence that interventions improved pain (Hedges’ g=-0.20, 95% CI=-0.35 to -0.06), negative affect (Hedges’ g=-0.35, 95% CI=-0.54 to -0.16) and hospital stay (mean difference=-0.52 days, 95% CI=-0.82 to -0.22). High levels of heterogeneity were found, necessitating exploratory secondary analysis. Discussion: Pre-operative psychological interventions improved post-surgical pain, affect and hospital stay length. However, caution is required in interpreting findings because of considerable heterogeneity in surgery types and interventions.