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Preparing for Surgery

General checklist for the days before upper-limb surgery — fasting, what to bring, medications.

Overview

Preoperative educational interventions demonstrate variable efficacy across orthopaedic procedures. While formal programs can reduce length of stay following hip or knee arthroplasty and modify patient expectations for total joint recovery, evidence for preoperative opioid education in elective hand surgery remains limited by small study numbers and poor quality [1, 2, 4]. In specific contexts such as surgical mission trips, preoperative classes may only modestly increase knowledge among underserved patients regarding total joint arthroplasty [6]. Furthermore, preoperative counseling utilizing haptic 3D hip models does not appear to improve patient-reported understanding or satisfaction for femoroacetabular impingement compared to CT imaging alone [8].

Successful outpatient management relies on proactive office and staff protocols that anticipate postoperative pitfalls associated with same-day discharge [3]. Enhancing communication, learning from peers, and treating patients beyond their radiographic findings are critical strategies to improve outcomes and trust [5]. Current research continues to evaluate the feasibility and satisfaction of structured programs like PREPS for individuals undergoing shoulder replacement [7].

Anatomy & Pathophysiology

Preoperative educational interventions demonstrate variable efficacy across surgical subspecialties. Formal programs can reduce length of stay following hip or knee arthroplasty [2] and modify patient expectations regarding recovery from total hip or knee arthroplasty [4]. Video counseling significantly decreases opioid consumption within the first week after total knee arthroplasty [9], whereas preoperative opioid education shows only some indication of favorable outcomes in elective hand surgery, limited by small study numbers and poor evidence quality [1].

Patient understanding and satisfaction are influenced by the modality of instruction. Preoperative counseling utilizing haptic 3D hip models does not favorably affect patient-reported understanding or satisfaction regarding femoroacetabular impingement compared with CT imaging alone [8]. Knowledge gains in underserved populations following preoperative classes during surgical mission trips remain modest [6], while a pilot randomized controlled trial is currently evaluating the feasibility and satisfaction of the PREPS program for shoulder replacement candidates [7].

Optimizing the surgical experience requires proactive system-level strategies and interpersonal communication. Enhanced office and staff protocols that anticipate postoperative pitfalls associated with same-day discharge facilitate safe outpatient experiences [3]. Furthermore, maximizing communication opportunities, learning from peers, and treating patients beyond their radiographic findings improve outcomes and trust [5].

Classification

Preoperative Education: Formal educational programs can modify patient expectations regarding recovery from total hip or knee arthroplasty [4] and reduce length of stay following these procedures [2]. Video counseling significantly decreases opioid consumption within the first week after total knee arthroplasty [9], while preoperative opioid education shows some indication of favorable outcomes following elective hand surgery, though evidence quality remains poor and data limited [1]. Enhanced office and staff protocols that are proactive rather than reactive facilitate safe same-day discharge by anticipating postoperative pitfalls [3].

Patient Communication and Modeling: Maximizing communication opportunities, learning from peers, and treating patients beyond radiographic findings improves outcomes and trust [5]. However, preoperative counseling using haptic 3D hip models does not favorably affect patient-reported understanding or satisfaction regarding femoroacetabular impingement compared with CT imaging alone [8]. Underserved patients' knowledge about total joint arthroplasty increased only modestly after attending a preoperative class during a surgical mission trip [6]. A pilot randomized controlled trial is currently evaluating the feasibility and satisfaction of the PREPS program for individuals undergoing shoulder replacement [7].

Other Considerations: Current evidence regarding preoperative education varies by population and modality, with some interventions showing significant impact on opioid use and length of stay while others demonstrate modest or null effects on patient understanding and satisfaction.

Clinical Presentation

Preoperative educational interventions demonstrate variable efficacy across surgical subspecialties. In elective hand surgery, opioid education shows some indication of favourable outcomes, though the number of studies were small, evidence quality was poor, and data were limited [1]. For total joint arthroplasty, formal preoperative educational programs can help to lower a patient's length of stay following hip or knee arthroplasty [2] and can modify patients' preoperative expectations of their recovery from total hip arthroplasty (THA) or total knee arthroplasty (TKA) [4]. However, in underserved populations during surgical mission trips, knowledge about total joint arthroplasty increased only modestly after taking a preoperative class [6].

Specific counseling modalities yield divergent results regarding patient understanding and resource utilization. Preoperative video counseling significantly decreased opioid consumption within the first week after total knee arthroplasty [9]. Conversely, preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction with regard to femoroacetabular impingement (FAI) when compared with the use of CT imaging alone [8]. While a pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing a shoulder replacement [7], broader improvements in patient outcomes and trust are achieved by maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings [5].

Successful outpatient management relies on proactive system-level protocols. Enhanced office and staff protocols that are proactive rather than reactive can provide a safe and successful outpatient experience by anticipating potential postoperative pitfalls associated with same-day discharge [3].

Investigations

Other Considerations: Preoperative educational interventions demonstrate variable efficacy across surgical domains. While formal programs can reduce length of stay following hip or knee arthroplasty [2] and modify patient expectations for total hip (THA) or total knee arthroplasty (TKA) [4], evidence for preoperative opioid education in elective hand surgery remains limited by small study numbers, poor quality, and restricted data [1]. Video counseling specifically significantly decreased opioid consumption within the first week after total knee arthroplasty [9]. In contrast, preoperative counseling using haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction regarding femoroacetabular impingement (FAI) compared with CT imaging alone [8]. Underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class during a surgical mission trip [6]. Enhanced office and staff protocols that are proactive rather than reactive can provide a safe and successful outpatient experience by anticipating potential postoperative pitfalls associated with same-day discharge [3]. Maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings can help improve patient outcomes and trust [5]. A pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing a shoulder replacement [7].

Treatment

Setting of Care

Proactive office and staff protocols that anticipate potential postoperative pitfalls can provide a safe and successful outpatient experience for same-day discharge [3]. Formal preoperative educational programs help lower a patient's length of stay following hip or knee arthroplasty [2]. Preoperative video counseling significantly decreased opioid consumption within the first week after total knee arthroplasty [9].

Adjuncts

Preoperative educational interventions modify patients' expectations of recovery from total hip arthroplasty (THA) or total knee arthroplasty (TKA) [4]. Preoperative opioid education shows some indication of favourable outcomes following elective hand surgery, though the number of studies was small, evidence quality was poor, and data were limited [1]. Underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class during a surgical mission trip [6]. Preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction regarding femoroacetabular impingement (FAI) when compared with the use of CT imaging alone [8]. A pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing shoulder replacement [7]. Maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings can help improve patient outcomes and trust [5].

Complications

Other Considerations: Preoperative interventions demonstrate variable impacts on surgical outcomes and patient experience. Preoperative opioid education shows some indication of favourable outcomes, though the number of studies were small, evidence quality was poor, and data were limited [1]. A formal preoperative educational program can help lower a patient's length of stay following hip or knee arthroplasty [2]. Enhanced office and staff protocols that are proactive rather than reactive can provide a safe and successful outpatient experience by anticipating potential postoperative pitfalls associated with same-day discharge [3]. Patients' preoperative expectations of recovery from total hip arthroplasty (THA) or total knee arthroplasty (TKA) can be modified by preoperative educational classes [4]. Maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings can help improve patient outcomes and trust [5]. Underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class during a surgical mission trip [6]. A pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing shoulder replacement [7]. Preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction regarding femoroacetabular impingement (FAI) when compared with the use of CT imaging alone [8]. Preoperative video counseling significantly decreased opioid consumption within the first week after total knee arthroplasty [9].

Recovery

Preoperative Education and Counseling: Preoperative opioid education shows some indication of favourable outcomes following elective hand surgery, though the number of studies were small, evidence quality was poor, and data were limited [1]. A formal preoperative educational program can help lower a patient's length of stay following hip or knee arthroplasty [2]. Preoperative video counseling significantly decreased opioid consumption within the first week after total knee arthroplasty [9]. Patients' preoperative expectations of their recovery from total hip arthroplasty (THA) or total knee arthroplasty (TKA) can be modified by preoperative educational classes [4]. Enhanced office and staff protocols that are proactive rather than reactive can provide a safe and successful outpatient experience by anticipating potential postoperative pitfalls associated with same-day discharge [3]. Maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings can help improve patient outcomes and trust [5]. Underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class during a surgical mission trip [6]. Preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction with regard to femoroacetabular impingement (FAI) when compared with the use of CT imaging alone [8]. A pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing a shoulder replacement [7].

Rehabilitation Protocol: Current evidence does not specify distinct phasing for physical therapy, immobilisation duration, weight-bearing progression, or sling/brace removal timing.

Functional Milestones: Validated patient-reported outcome measure (PROM) trajectories or specific benchmark values are not detailed in the provided evidence base.

Other Considerations: Preoperative education and counseling strategies are critical for managing opioid consumption, length of stay, and patient expectations, though efficacy varies by modality and patient population.

Key Evidence

  • [L1] There was some indication of favourable outcomes following preoperative opioid education; however, the number of studies were small, the evidence quality was poor, and data were limited. (10.1177/17589983241301449)
  • [L3] A formal preoperative educational program can indeed help to lower a patient's length of stay. (10.1016/j.arth.2009.03.012)
  • [L5] Enhanced office and staff protocols that are proactive rather than reactive can provide a safe and successful outpatient experience by anticipating potential postoperative pitfalls associated with the unique 'ripple effects' of same-day discharge. (10.1016/j.arth.2019.01.001)
  • [L1] Patients' preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes. (10.1007/s11999-007-0052-z)
  • [L5] The author emphasizes that maximizing opportunities to improve communication, learning from others, and treating patients as more than their radiographic findings can help improve patient outcomes and trust. (10.2106/jbjs.24.01274)
  • [L4] On this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. (10.1016/j.arth.2020.04.084)
  • [L2] This pilot randomized controlled trial will evaluate the feasibility and satisfaction of the PREPS program for individuals undergoing a shoulder replacement. (10.1177/17589983251345393)
  • [L2] Preoperative counseling with haptic 3D hip models does not appear to favorably affect patient-reported understanding or satisfaction with regard to FAI when compared with the use of CT imaging alone. (10.1177/2325967118794645)
  • [L1] This study found significantly decreased opioid consumption within the first week after TKA in patients who received preoperative video counseling. (10.1016/j.arth.2024.02.027)

References

[1] The effect of preoperative interventions on postoperative outcomes following elective hand surgery: A systematic review. Hand Therapy. 2024. DOI: 10.1177/17589983241301449

[2] Patient Education Before Hip or Knee Arthroplasty Lowers Length of Stay. The Journal of Arthroplasty. 2010. DOI: 10.1016/j.arth.2009.03.012

[3] Considerations for Office and Staff Protocols for Outpatient Joint Replacement. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.01.001

[4] Randomized Trials to Modify Patients' Preoperative Expectations of Hip and Knee Arthroplasties. Clinical Orthopaedics & Related Research. 2008. DOI: 10.1007/s11999-007-0052-z

[5] What’s Important: Treat the Patient Instead of the Disease. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01274

[6] Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.04.084

[7] Preoperative rehabilitation and education program for surgery (PREPS): A pilot randomized control trial protocol. Hand Therapy. 2025. DOI: 10.1177/17589983251345393

[8] Patient-Specific 3-Dimensional Modeling and Its Use for Preoperative Counseling of Patients Undergoing Hip Arthroscopy. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118794645

[9] The Efficacy of Preoperative Video-Based Opioid Counseling on Postoperative Opioid Consumption After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.02.027

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