Impact of Preoperative Educational Video on Anxiety in Patients Undergoing Pelvic Organ Prolapse Surgery

INTRODUCTION: Pelvic organ prolapse (POP) surgery commonly causes acute situational anxiety in up to 80% of patients. Preoperative anxiety can negatively influence anesthesia requirements, postoperative pain, nausea and vomiting, and overall patient satisfaction with surgery outcomes. Addressing patient anxiety preoperatively is crucial, as it is correlated with dissatisfaction and reduction in perceived treatment efficacy. Traditional verbal education during preoperative visits may not fully alleviate patient concerns, leading some practitioners to explore audiovisual methods. While preoperative education videos have shown promise in reducing anxiety and improving information retention in various surgical populations, their effectiveness in urogynecology remains unclear. OBJECTIVE: To determine if the use of a perioperative educational video reduces preoperative anxiety as measured by the Surgical Anxiety Questionnaire (SAQ) compared to traditional verbal education in patients undergoing POP surgery. METHODS: This was a blinded, randomized controlled trial of women undergoing apical repair POP surgery between December 2022 and October 2024. Participants were randomized to receive either the preoperative verbal education or a surgical education video during their preoperative visit. Patients enrolled in the video group had access to re-watch the video at home. On the day of surgery, all patients were given the validated SAQ preoperatively. Each of the 17 questions on the SAQ is scored 0–4, with a minimum total score of 0 and a maximum of 68. The primary outcome was preoperative anxiety level in each group as measured with the SAQ. Secondary outcome was assessment of anxiety levels in patients taking an anxiety medication. A sample size of 67 participants per arm was calculated to detect a medium effect size on anxiety reduction (Cohen’s d 0.5). RESULTS: 127 subjects were included in the analysis with similar demographics between groups. For the primary outcome, there was no significant difference in preoperative anxiety levels between groups. The median SAQ score in the control arm was 7.5 (IQR 3.75–13.25) compared to 7 (IQR 3–15.5) in the video arm (p=0.76). The proportion of patients on anxiety medication did not differ significantly between the control (20.3%) and video (27.4%) arms (p=0.41). Additionally, patients taking anxiety medication did have higher median SAQ scores [9.5 (IQR 6–13.75)] compared to those not taking medication [6 (IQR 2–14)], although the difference was not significant (p=0.09). CONCLUSIONS: In patients undergoing prolapse surgery, the use of a replayable perioperative educational video did not reduce preoperative anxiety compared to usual verbal education. These findings suggest that while audiovisual tools may enhance patient education and retention, their impact on anxiety reduction in this population may be limited, and additional strategies may be needed to effectively manage preoperative anxiety. It is reassuring that overall preoperative anxiety scores were low, possibly due to extensive counseling regardless of the route. Further studies investigatng specific areas of greatest concern for patients in the postoperative period, such as pain, indwelling catheter, or return to activity, may be more valuable than overall preoperative education.