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What is the effect of preoperative education on
patient outcomes after joint replacement
surgery? Principal Investigator Marge Kearney
APN, ONC1 Sub-Investigators Mary Kay Jennrich
RN, BSN1, Stephanie Russo DPT, MSCS1, Rochelle
Robinson RN, ONC1, Sheri Wilhelmi RN, BSN1,
Stephanie Wink RN, BSN1, Dan Felice MPT1, Lisa
Orlet MPT1, Barbara Berger PhD, RN2 1 Advocate
Good Samaritan Hospital, 2 University of
Illinois at Chicago
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Abstract
Conclusions/Discussion
Purpose/Research Questions
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.
Findings (continued)
Findings

• 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?

• 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 3 CLINICAL 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.
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 patients 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.

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.
Background
Contact information
Marge Kearney APN, ONC c/o Advocate Good Samaritan Hospital 3815 Highland Avenue Downers Grove, IL 60515 630-275-3599 Marge.Kearney_at_advocatehealth.com Marge Kearney APN, ONC c/o Advocate Good Samaritan Hospital 3815 Highland Avenue Downers Grove, IL 60515 630-275-3599 Marge.Kearney_at_advocatehealth.com

TABLE 4 COMPLICATIONS
TABLE 2 PATIENT PERCEPTIONS
Complications Complications
Class attendance Yes No test statistic p value
Face-to-face (f2f) class No class 4 8 73 65 X21df 1.692 .193
Structured education (f2f or on-line) No structured education 4 8 84 54 X21df 3.452 .063
Acknowledgements
Analysis
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.
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.