Barriers and facilitators to surgical patients’ engagement in preoperative experience services: a cross-sectional survey

Patient engagement in the preoperative period can improve surgical outcomes, but many patients do not fully utilize preoperative programs. We aimed to identify barriers and facilitators influencing surgical patients’ engagement in preoperative experience services at Xiangya Hospital, Changsha. A cross-sectional observational study was conducted from February 2024 to March 2025. Two hundred adult patients scheduled for elective surgery across various specialties were surveyed preoperatively. Engagement was defined as participation in at least one preoperative experience service (education classes, counseling sessions, prehabilitation programs, etc.). Data on demographics, clinical factors, and perceived barriers and facilitators were collected using structured questionnaires. Open-ended responses were examined using descriptive qualitative content analysis to contextualize the quantitative findings. Overall, 59.5% (119/200) of patients engaged in preoperative services. Engagement rates varied by surgical type (e.g., cardiac surgery 82.4% vs. neurosurgery 40.0%). Key barriers to engagement included time constraints (reported by 69.1% of non-engaged vs. 27.7% of engaged patients, p < 0.001) and difficulty traveling to the hospital (54.3% vs. 19.3%, p < 0.001). Lack of awareness of services, low perceived need, and anxiety or avoidance of pre-surgery information were also significantly more common in non-engaged patients (all p < 0.05). Major facilitators included strong provider recommendations (reported by 66.4% of engaged vs. 23.5% of non-engaged, p < 0.001) and family support (49.6% vs. 13.6%, p < 0.001). Patients who engaged had lower preoperative anxiety scores and higher preparedness scores than those who did not ( p < 0.01). Multivariate analysis showed that higher education (OR = 2.16, 95%CI 1.17–3.99), younger age (OR = 0.98 per year, 95%CI 0.95–1.00), and cardiac surgery (OR = 3.67 vs. general surgery, 95%CI 1.27–10.63) were independent predictors of engagement. Qualitative responses reinforced the quantitative findings, e.g., patients often cited “no time due to work” and “no one told me about the class” as reasons for non-participation, while engaged patients emphasized “wanting to be prepared” and “encouragement from doctors/family”. Surgical patient engagement in preoperative services was impeded by logistical, informational and motivational barriers, while clinician encouragement and social support strongly facilitated engagement. Interventions such as flexible scheduling, enhanced patient education outreach and involvement of family supporters may mitigate barriers. These findings can guide strategies to improve preoperative patient engagement and thus potentially enhance surgical outcomes.