Perioperative Quality Initiative consensus statement recommendations on the definition, development, implementation and outcomes of pre-operative surgery schools

Imogen Fecher-Jones; Ben Ainsworth; Tong J Gan; S Ramani Moonesinghe; Andrew D Shaw; Michael P W Grocott; Denny Z H Levett; Perioperative Quality Initiative Surgery School Consensus Group

doi:10.1111/anae.16648

Perioperative Quality Initiative consensus statement recommendations on the definition, development, implementation and outcomes of pre-operative surgery schools

Anaesthesia. 2025 Jun 21. doi: 10.1111/anae.16648. Online ahead of print.

Authors

Imogen Fecher-Jones¹, Ben Ainsworth², Tong J Gan^{3

4}, S Ramani Moonesinghe^{5

6}, Andrew D Shaw⁷, Michael P W Grocott⁸, Denny Z H Levett⁸; Perioperative Quality Initiative Surgery School Consensus Group

Collaborators

Perioperative Quality Initiative Surgery School Consensus Group:
Anna M Anderson, Leah Avery, Gabriele Baldini, Angie Balfour, Rachael Barlow, Esther Carr, Daniel Conway, Robert J Copeland, Anh Dang, Andrew Davies, Mark R Edwards, Rochelle Furtado, Chelsia Gillis, Hilmy Ismail, Sandy Jack, Carol Keen, Ruth McDonald, Scarlett McNally, Zoe Merchant, Claire Moore, John Moore, Judith Partridge, Jashvant Poeran, Brocha Z Stern, Janius Tsang

Affiliations

¹ Department of Perioperative Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
² School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
³ Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Austin, Texas, USA.
⁴ Division of Anesthesiology, MD Anderson Cancer Center, Houston, TX, USA.
⁵ NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, London, UK.
⁶ Department of Targeted Intervention, University College London, London, UK.
⁷ Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, OH, USA.
⁸ NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of Southampton, Southampton, UK.

PMID: 40542644
DOI: 10.1111/anae.16648

Abstract

Introduction: Pre-operative group sessions incorporating patient education and behaviour change interventions, known as 'surgery schools', are becoming increasingly common before major elective surgery across the world. However, there is a lack of conclusive evidence regarding the effectiveness of surgery schools, and the development and delivery of these complex interventions lacks standardisation.

Methods: In collaboration with the Perioperative Quality Initiative, we aimed to develop evidence- and expertise-based consensus statements and recommendations regarding the definition, design, content, and outcomes of surgery schools. Thirty-two international multidisciplinary experts in surgery school and pre-operative preparation attended a series of virtual meetings based on a modified Delphi methodology. A systematic review and additional targeted literature searches were used to propose statements for the definition, design, content and outcomes of surgery schools. Statements and recommendations were discussed iteratively and refined in multiple rounds, until agreement was reached.

Results: Consensus was reached on a definition of surgery school, as well as three statements and 18 recommendations in relation to: scope; outcomes; intervention development; delivery; inclusivity; and educational content of surgery schools. Seventeen areas were highlighted as priorities for future research.

Discussion: These consensus statements and recommendations are intended to help clinicians and service managers who plan to develop and implement surgery schools. They may improve the quality of those programmes and help to standardise their content. We also hope that this work will influence government strategy and policy in relation to the design, delivery and funding of peri-operative optimisation pathways.

Keywords: Delphi consensus; peri‐operative medicine; pre‐operative education; surgery school, prehabilitation.