Experts reach landmark consensus on surgery schools

Researchers have come to widespread agreement on how surgery schools should be delivered across the world.

Surgery school is a group education class. Patients can attend it in the weeks before planned surgery. This helps them to prepare physically and emotionally.

Research suggests that this preparation can lead to shorter hospital stays and quicker recovery times. It can also result in the patient having a better experience due to them being more informed.

Although surgery schools are delivered across the UK and in many other parts of the world, there is a lack of standardisation in how they are designed and delivered. There is significant variation in what patients are taught.

New research has sought to reach the first consensus among experts in the field. This work was led by researchers from the NIHR Southampton Biomedical Research Centre (BRC). They worked in collaboration with the international Perioperative Quality Initiative.

Their recommendations have been published in the journal Anaesthesia.

Preparing for surgery

Patients who increase their physical activity, avoid becoming malnourished and proactively manage their emotional well-being have been shown to have better outcomes from surgery.

Surgery schools have become part of standard care in many settings. Some are face-to-face group sessions, and others are virtual.

University Hospital Southampton (UHS) began offering surgery school in 2015. It was one of the first places in the UK to do so.

Since the COVID-19 pandemic, UHS has delivered surgery school as an interactive video conference call. The one-off session lasts for an hour and a half.

Around ten patients attend each session. Family and friends are also encouraged to attend.

The session helps patients prepare for their operation by making changes to their lifestyle. It covers nutrition, emotional wellbeing, exercise and what to expect.

At the end of the session, patients set goals based on what they’ve learnt.

Reaching an agreement

Imogen Fecher-Jones has led surgery school at UHS since it began. She is an advanced nurse practitioner and doctoral researcher.

She identified the lack of agreement internationally regarding what surgery schools are. Her research showed significant variation in how they are delivered and what information patients receive.

A series of consensus workshops were arranged in collaboration with the Perioperative Quality Initiative (POQI). POQI is an international multidisciplinary non-profit organisation. It organises expert consensus conferences about perioperative care.

Thirty-two international multidisciplinary experts attended the virtual workshops. These experts were each selected for their clinical expertise in surgery school and pre-operative preparation. Their academic track record was also taken into account.

The meetings used a technique called the Delphi method. It involves gathering everyone’s opinions to form a consensus. The following definition was developed:

‘Surgery school is an education and behaviour change intervention, delivered by healthcare professionals to groups of patients and their family, friends and carers, which aims to prepare them for major surgery.’

The group was unanimous about the aims of surgery school. They all agreed that it should be an interactive and engaging experience for patients and their support networks. They also felt that there should be a focus on supporting patients to be successful in lifestyle behavioural change.

Informing best practice

The group developed three consensus statements and eighteen recommendations. Each achieved at least 85% agreement through the voting process.

They made recommendations on how surgery schools should be designed and delivered. They covered what content should be included.

The group also identified priorities for future research in this field.

These recommendations will guide teams setting up surgery schools in the future. NHS England has adopted them within their ‘Surgery School Clinician Toolkit’. They are due to release the toolkit later this year.

Imogen Fecher-Jones is currently undertaking doctoral studies. These are sponsored by UHS, Southampton Academy of Research and the National Institute of Academic Anaesthetists. She said: “I am enormously proud of what we have achieved. Patients have told us how useful they find attending surgery school. Many make successful lifestyle changes as a result of attending.

“Having these recommendations means that any secondary care provider can set up an effective surgery school. They will be following the best available evidence and expert advice.

“We hope this will result in more patients having access to surgery schools across the world.”

Professor Denny Levett and Professor Mike Grocott made significant contributions. They jointly lead the NIHR Southampton BRC’s Perioperative and Critical Care theme.

Professor Grocott, who is president of the POQI, said: “The POQI team are delighted to have enabled this excellent work led from Southampton. It will be a landmark in improving perioperative care through the development of surgery schools.”