From operating room to recovery: Evidence and gaps in cardiac surgical nursing integrative psychological support

Abstract

This review explored the application and effectiveness of and research gaps in integrative psychological support in patients undergoing cardiac surgery during the perioperative period. These patients often encounter psychological issues such as anxiety and depression, which affect their postoperative recovery and quality of life. Previous research indicated that preoperative psychological assessments and interventions significantly enhance patients’ psychological states and postoperative outcomes. Interventions, including preoperative education, mindfulness-based stress reduction, and cognitive training, have proven effective in reducing the incidence of postoperative delirium and anxiety. Intraoperative environment optimization (e.g., music therapy) and postoperative psychological support (e.g., family visits and psychological interventions in intensive care unit psychological interventions) positively influence patient recovery. Furthermore, theory-based nursing interventions and digital health tools (e.g., remote monitoring applications) offer new directions for psychological support. However, challenges, including fragmented psychological support, insufficient cross-stage integration, and inadequate training, remain in current nursing practices. Future research should focus on developing standardized psychological support pathways, enhancing multidisciplinary collaboration, and verifying the long-term effects of digital therapeutics.

Key Words: Cardiac surgical nursing; Integrative psychological support; Preoperative psychological assessment and intervention; Postoperative psychological support; Digital health tools; Multidisciplinary collaboration

Core Tip: Cardiac surgery patients often experience psychological issues like anxiety and depression, which impact recovery and quality of life. Perioperative psychological interventions effectively reduce these issues and improve outcomes. However, current care guidelines have limitations. This review assesses integrative psychological support in cardiac surgical nursing, highlighting effective interventions and identifying gaps to guide future research and enhance nursing practices.

INTRODUCTION

Although cardiac surgery can save lives, it is associated with significant psychological issues. Studies showed that patients undergoing cardiac surgery experienced high levels of anxiety and depression, which negatively affected their recovery, postoperative care compliance, and overall quality of life (QoL)[1,2]. Globally, the incidence of psychological disorders after cardiac surgery is relatively high. Approximately 50% of patients report experiencing anxiety, stress, and/or depression, and at least 10% meet the clinical diagnostic criteria[3]. An Italian survey reported that one month after coronary artery bypass graft (CABG), 10.6% of patients had severe depression, and 12.8% had persistent depression[4]. Research in Australia showed that among patients before CABG, the incidence of depressive symptoms was 17.1%, and the incidence of anxiety symptoms was 10.2%[5].

Preoperative and postoperative mental health significantly affect surgical outcomes, with preoperative anxiety and depression linked to postoperative complications[6,7]. Psychological interventions during the perioperative period of cardiac surgery are crucial to alleviating emotional stress in patients. Research indicates that these interventions effectively reduce anxiety and depression and improve postoperative recovery[8,9]. Preoperative psychological assessments and interventions are vital for enhancing the postoperative QoL[10]. Mental health issues hinder physiological recovery and increase postoperative complications. Severe mental health problems, such as psychiatric disorders, are associated with higher mortality and complication rates after cardiac surgery[11]. Therefore, monitoring patients’ mental health throughout cardiac surgery and providing appropriate psychological support and interventions are essential for improving surgical outcomes and QoL.

This review aimed to systematically evaluate the evidence for integrative psychological support in cardiac surgical nursing from preoperative to postoperative recovery stages. This includes examining the effectiveness of various psychological interventions [e.g., cognitive-behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and psychosocial counseling] in improving patient outcomes. Moreover, this review analyzes the limitations of the current care guidelines related to psychological support in cardiac surgery. By identifying these gaps, we aim to suggest future research directions and guide the development of more comprehensive and effective nursing interventions.

INTEGRATIVE PSYCHOLOGICAL SUPPORT ACROSS SURGICAL PHASES

Psychological interventions for patients undergoing cardiac surgery are typically divided into three phases: Preoperative, intraoperative, and postoperative. Each phase addresses specific psychological challenges faced by patients and aims to reduce anxiety, depression, and postoperative complications while improving the overall recovery and QoL. The detailed methods and specific procedures of these interventions are summarized in Table 1.

Table 1 Details of integrative psychological support during the perioperative period of cardiac surgery.

Intervention timing	Participants	Methods	Details (frequency, duration, specific operations)
Preoperative intervention	Children aged 6–12 years	Comic story[15]	Each child receives a free educational comic book, "An Introductory Trip to the Operating Room", and spends 10–15 minutes reading it
	Patients aged 40–70 years undergoing coronary artery bypass graft (CABG)	Multidisciplinary education program[17]	Single intervention including educational booklet, nurse training, and routine care. Educational booklet: Patients in the intervention group receive guidance on the surgical process, expected outcomes, and postoperative care. Nurse training: Nurses train patients preoperatively to understand the booklet's content
	Cardiac rehabilitation patients aged 21 years who had heart surgery in the past 12 months	Mindfulness-based stress reduction (MBSR)[18]	Weekly 2.5-hour sessions for 8 weeks, plusa 65-hour retreat. MBSR courses are led by trained and certified instructors
	Patients aged 29–70 years undergoing CABG	Cognitive training[19]	Weekly sessions lasting 30–40 minutes for 6 weeks. Includes three one-on-one mindfulness exercises: Body scanning (during hospitalization), mindfulness breathing, and seated meditation (via phone post-discharge)
Intraoperative intervention	Patients undergoing cardiac surgery aged 35–89 years	Verbal suggestion and touch therapy[21]	Face-to-face interview about 2 weeks preoperatively to collect medical history, socioeconomic background, general health, health behaviors, function, and preoperative anxiety symptoms. A phone call 48 hours preoperatively to assess character strengths and perceived social support
	Patients undergoing cardiac surgery aged 20–86 years	Providing transparent and timely information[24]	One-time intervention during the middle of the surgery and postoperatively. The nurse provides brief information updates to family members during the middle of the surgery, including progress to halfway and the location of the recovery room. No clinical data or results are included
	Patients undergoing cardiac surgery aged 18–78 years	Music therapy[27]	On the first afternoon post-surgery, from 3:00 to 4:00 PM, patients lie in bed at a 30- to 40-degree angle for 30 minutes. Patients select their preferred music from 20 options provided by researchers, played via portable recorder and headphones at 50–60 dB
Postoperative intervention	Patients requiring cardiac surgery, including CABG or other cardiac surgeries	Nonpharmacological multicomponent interventions (restoring circadian rhythms, activating body and mind, inducing relaxation)[30]	All are one-time interventions. Virtual reality (VR) relaxation training: Patients receive VR relaxation training preoperatively, experiencing a relaxing virtual environment via VR devices to alleviate anxiety. Artificial intelligence (AI) emotion monitoring: AI technology monitors patients' emotional states, providing real-time feedback and intervention suggestions. Mobile application (app): Patients use a mobile app for postoperative recovery management, including pain management, activity monitoring, and emotional support. Wearable devices: Patients wear devices like smartwatches to monitor physiological parameters such as heart rate and blood pressure, with data support provided via the mobile app
	Patients with severe illness unable to communicate	Communication alternatives[35]	Communication tools (e.g., writing boards, picture communication systems, electronic devices) are provided and used as needed, with guidance on proper use. Tool usage duration varies from minutes to hours based on patient needs and communication complexity, with timely adjustments based on feedback
	Patients aged 52–68 years undergoing cardiopulmonary bypass surgery	Theory-based nursing interventions[36]	Health education: Includes twice-weekly 30-min face-to-face interviews during hospitalization and home visits post-discharge. Topics cover disease knowledge, postoperative recovery, and a healthy lifestyle (e.g., exercise, diet, smoking cessation, weight management). Psychological support: Provides psychological support to help patients cope with postoperative anxiety and depression, using techniques like feedback listening, inductive questioning, and conflict analysis to resolve contradictions between health behaviors and recovery goals. Behavioral incentives: Motivates patients to change health behaviors through specific health goals, educational materials, self-monitoring, and self-efficacy enhancement. Frequency and duration: Twice-weekly 30-minutes interviews during hospitalization. Post-discharge home visits: Weekly in month 1, biweekly in months 2–3, every three weeks in months 4–5, and monthly in month 6, each lasting 20 min
	Patients aged 50–70 years who have undergone CABG	Cognitive behavioral therapy[37]	Through face-to-face interviews, homework, relaxation training, and cognitive restructuring, patients learn to identify and change maladaptive cognitive patterns and behaviors. Preoperative intervention includes 5 weekly 30-minutes face-to-face interviews. Postoperative intervention includes 12 weekly 60-minutes interviews for 3 months or 4 weekly 30-min interviews for 4 weeks

CABG: Coronary artery bypass graft.

Preoperative phase

Assessment scales and their effectiveness: The Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI) are widely used tools for psychological risk screening in patients undergoing cardiac surgery. The HADS has been extensively studied and validated in these patients. One study reported that the HADS showed good sensitivity and specificity for identifying depression in patients with acute coronary syndrome and chronic coronary artery disease, with a total score cut-off of 14[12]. Another systematic review showed that the HADS-D (depression subscale) showed good sensitivity and negative predictive value for detecting depression and recommended its use in depression screening and monitoring during cardiac rehabilitation[13]. The HADS has been validated in other studies as an effective tool for identifying patients with psychological distress in cardiac settings[14].

The STAI, which measures state and trait anxiety, provides a comprehensive assessment of patient anxiety levels, which is crucial for preoperative psychological evaluations in cardiac surgery. In a study of patients after CABG, female patients had significantly higher STAI scores than male patients both preoperatively and six months postoperatively, indicating that STAI helped identify patients with high anxiety who may have poor postoperative adjustment[15]. In a study on the remote rehabilitation of patients with heart failure, the STAI was used to assess anxiety levels. The results showed that while no significant change in anxiety levels was reported across the entire study population, younger patients experienced a decrease in anxiety, whereas older patients experienced an increase. This suggests that the STAI helped identify anxiety patterns in patients of different age groups, thus providing a basis for personalized psychological interventions[16].

Another study examined the use of STAI to assess preoperative anxiety in Turkish surgical patients. The findings revealed that age, sex, and preoperative sleep duration were significant predictors of state anxiety scores, whereas educational level and age were the best predictors of trait anxiety scores. This further confirms the applicability and effectiveness of the STAI in diverse populations[17].

Although both HADS and the STAI are used for psychological risk screening, each has its own focus in the assessment of anxiety and depression. First, the HADS is a self-report scale specifically designed for hospital settings and is mainly used to screen for symptoms of anxiety and depression in hospitalized patients. Studies have shown that the HADS has good internal consistency and validity in various patient groups. For example, in one study, the HADS was used to assess psychological distress in patients with cardiovascular disease, and the results showed a good correlation with other validated scales[14]. The HADS has been widely validated and applied in different cultural and linguistic contexts. For example, among gynecological patients in Poland, the HADS has demonstrated good psychometric properties[18]. In contrast, the STAI is a more comprehensive anxiety assessment tool consisting of two parts: State anxiety and trait anxiety. It is used not only to assess the current state of anxiety but also to evaluate long-term anxiety traits. Studies have reported differences between the STAI and HADS in anxiety assessment. For example, among patients with implanted cardiac defibrillators, the STAI showed a higher prevalence of anxiety, indicating that the STAI may be more sensitive than the HADS in detecting anxiety symptoms[19].

Interventions

Preoperative education: Preoperative education is crucial for patients undergoing cardiac surgery, as it reduces anxiety by familiarizing them with the surgical process, expected outcomes, and postoperative care. This intervention corrects the patient’s perception of the surgery and significantly decreases preoperative anxiety and postoperative complications. One study observed that preoperative guidance using educational comic strips effectively increased pediatric patient knowledge and reduced anxiety[20]. Another study reported that a single preoperative multidisciplinary education session improved postoperative satisfaction and recovery of patients who underwent spinal fusion surgery[21]. In cardiovascular surgery, educational booklets and nursing guidance reduce postoperative pain and anxiety in patients undergoing CABG while enhancing self-efficacy[22]. Such educational interventions boost postoperative satisfaction and reduce complication rates.

MBSR: MBSR, an evidence-based intervention, has been proven effective in reducing anxiety and enhancing mental health across various groups. Moreover, it improves the mental well-being of patients undergoing cardiac surgery. A randomized controlled trial on cardiac rehabilitation patients showed that MBSR improved depressive and anxiety symptoms and had positive effects on health-related QoL[23]. Another study focused on patients receiving percutaneous coronary intervention and observed that, compared to the waitlist group, the MBSR group showed significant improvements in anxiety and perceived stress[24].

Cognitive training: Ramesh et al[25] investigated the impact of preoperative cognitive training on the incidence of postoperative delirium in patients undergoing CABG surgery. The trial was conducted at three university teaching hospitals in southeastern China between April 2022 and May 2023. A total of 218 patients were randomized, and 208 were included in the final analysis. The median age of the participants was 66 years, with 64 females (30.8%) and 144 males (69.2%). The study compared two groups: one receiving routine care and the other undergoing cognitive training, which involved online tasks designed to enhance cognitive functions such as memory, imagination, reasoning, reaction time, attention, and processing speed. The primary outcome was the occurrence of delirium during postoperative days 1–7 or until hospital discharge, diagnosed using the Confusion Assessment Method or the Confusion Assessment Method for Intensive Care Units. The results showed that 27.5% of patients in the cognitive training group developed delirium compared with 43.4% in the routine care group. Patients who received cognitive training were 57% less likely to develop delirium [adjusted odds ratio (aOR) 0.43; 95%CI: 0.23–0.77; P = 0.007]. Additionally, significant differences were observed in the incidence of severe delirium (aOR, 0.46; 95%CI: 0.25–0.82; P = 0.01), the median duration of delirium [0 (0–1) days for cognitive training vs 0 (0–2) days for routine care; P = 0.008], and the median number of delirium-positive days [0 (0–1) days for cognitive training vs 0 (0–2) days for routine care; P = 0.007]. These findings suggest that preoperative cognitive training effectively reduces the incidence of postoperative delirium in patients undergoing CABG.

Intraoperative phase

Nurse-patient communication: Before cardiac surgery, anesthesia induction is a critical and anxiety-provoking phase in patients. Calming techniques, such as verbal reassurance and touch therapy, alleviate preoperative anxiety and may positively affect recovery and treatment outcomes. For example, preoperative optimism has been linked to lower postoperative anxiety, which is clinically significant for disease management[26]. Music therapy in the preoperative waiting area also significantly reduced preoperative anxiety, as evidenced by decreased heart rates and anxiety scores among patients listening to relaxing music[27]. Psychological interventions are effective in reducing anxiety and improving outcomes in both the preoperative and postoperative phases[29]. Additionally, family members in surgical waiting areas often experience anxiety owing to uncertainty regarding the surgical process and outcomes. Anxiety affects mental state and potentially influences psychological state through emotional contagion. Providing transparent and timely information reduces family anxiety and indirectly enhances postoperative recovery[29].

Intraoperative environment optimization: Music therapy is a non-invasive intervention that improves intraoperative and postoperative experiences, aids recovery, and reduces analgesic requirements. During cardiac surgery, music therapy reduces physiological stress responses by decreasing cortisol levels, thereby promoting recovery[30]. It also reduced postoperative pain and anxiety. For instance, in patients undergoing open-heart surgery, listening to preferred music significantly increases oxygen saturation and reduces pain scores, highlighting its potential to mitigate harmful physiological responses to postoperative pain[31]. Music therapy has gained attention owing to its postoperative recovery benefits. In patients undergoing thoracic surgery, it significantly reduces pain, anxiety, systolic blood pressure, and heart rate, underscoring its value in postoperative care, particularly in reducing complications and promoting faster recovery[32].

Postoperative phase

Postoperative visitation: One study reported that allowing family members to visit patients after surgery significantly reduced family anxiety, although this may not have been eliminated entirely[33]. Another study suggested that providing detailed postoperative reports and involving family members during postoperative visits eased their anxiety[29].

Intensive care unit transition psychological trauma: Maintaining the circadian rhythm of the patient during the intensive care unit (ICU) transition after cardiac surgery is crucial for preventing delirium. Nonpharmacological sleep interventions, such as multicomponent interventions and circadian rhythm regulation, effectively reduce the incidence of delirium and significantly improve sleep quality in postoperative ICU patients[34]. Technology-supported nonpharmacological multicomponent interventions are recommended to prevent and reduce hospital delirium. These include strategies such as restoring circadian rhythms, activating the body and mind, and inducing relaxation[35]. Orientation training, another effective delirium prevention strategy, lowers delirium rates by improving cognitive function and orientation. Preoperative psychological education significantly reduces delirium rates in patients undergoing cardiac surgery by enhancing their understanding of the surgical process and postoperative recovery, helping them adapt better to the postoperative environment[36].

Communication alternatives for patients on mechanical ventilation: After cardiac surgery, patients on mechanical ventilation often face significant psychological stress owing to their inability to communicate verbally. Communication difficulties are a key contributor to this stress[37]. In ICUs, intubated patients cannot communicate verbally, posing challenges for healthcare providers to understand their needs and feelings and worsening anxiety and fear[38].

Alternative communication methods are an effective way to relieve stress. For example, writing boards and gesture systems help patients express their needs and feelings, thus reducing the psychological burden of communication barriers[39]. A Study has shown that specialized communication tools such as communication boards and high-tech assistive communication devices greatly improve patient communication satisfaction and reduce anxiety and fear[40].

Theory-based nursing interventions: Zhao et al[40] studied the effects of theory-based nursing interventions on cardiac function recovery and QoL in patients who underwent cardiac surgery. The study included 120 patients scheduled for cardiopulmonary bypass surgery, who were randomly divided into control and observation groups of 60 patients each. The control group received routine care, whereas the observation group received theory-based interventions, including health education, psychological support, and behavioral incentives. The results showed that these interventions significantly improved the postoperative cardiac function and QoL. They increased the left ventricular ejection fraction, reduced left ventricular diameter, lowered inflammatory markers (tumor necrosis factor-α and interleukin), and improved patient mental health and social functioning. This study highlights the importance of integrating behavioral and psychological support in cardiac rehabilitation and provides valuable insights for future postoperative care.

Long-term rehabilitation psychological support: Ibrahim et al[41] assessed the effectiveness of CBT in reducing postoperative anxiety and depression in patients undergoing CABG and in improving their QoL. CBT significantly reduced anxiety and depression, shortened hospital stay, increased treatment satisfaction, and resulted in no serious adverse events. Dao et al[42] reported that CBT reduced anxiety and depression during hospitalization. Freedland et al[43] revealed that CBT is more effective than usual care in alleviating depression and anxiety. Højskov et al[44] indicated that psychoeducational interventions improved QoL. Despite these positive findings, the studies had limitations such as heterogeneity and small sample sizes. Future studies should focus on larger sample sizes, long-term effects, and cost-benefit analyses to further validate the value of CBT in patients undergoing CABG.

SPECIAL FOCUS: APPLICATION POTENTIAL OF DIGITAL HEALTH TOOLS (SUCH AS APP REMOTE MONITORING)

Patients who undergo cardiac surgery experience stress and anxiety, which leads to complications and hinders their recovery. The effective management of these psychological factors is crucial for improving patient outcomes. Psychological interventions during the perioperative period are vital for enhancing patients’ mental health and surgical outcomes. The recent introduction of digital health tools has ushered in new possibilities in the field. Improved psychological health management support is provided through remote monitoring technologies, such as apps. This led to more effective remote monitoring, greater patient engagement, and significant improvements in mental health and postoperative recovery.

Digital health tools offer personalized psychological support to help patients cope with postoperative stress and anxiety during the perioperative period. Kondylakis et al[45] explored the feasibility of digital health interventions in reducing perioperative stress and anxiety (NCT05184725). Adhera CARINAE DH, a digital ecosystem combining wearables, mobile apps, and virtual reality (VR), was used in this study. The results showed that postoperative patients (including those who underwent cardiopulmonary and coronary artery bypass surgeries and cardiac valve replacement) in the Adhera CARINAE DH intervention group showed significant improvements in multiple psychological outcomes. For example, the visual analog scale (VAS) score for stress improved by 5% on admission and 11.1% at discharge, whereas the VAS score for pain on admission improved by 31.2%. The HADS for postoperative anxiety showed a 15.6% improvement, and the Positive and Negative Affect Scale for negative affect on admission demonstrated a 17.5% improvement. On average, patients in the intervention group had 17.12% shorter hospital stays. Moreover, the intervention group exhibited more positive connections with self-efficacy, self-management, and mental well-being, indicating that CARINAE may help reduce stress and negative emotions. These tools provide evidence-based personalized management approaches to help patients deal with their psychological challenges.

Second, remote monitoring technologies can enhance the efficiency and accuracy of postoperative monitoring. Using smartphone applications, patients regularly record physiological data such as heart rate after surgery, enabling the early detection of potential complications. A previous study showed that a smartphone application based on photoplethysmography could effectively detect the prevalence of atrial fibrillation and other arrhythmia-related complications after cardiac surgery and link them to potential postoperative complications[46]. Most participants (74%) and primary care physicians found the application valuable as it increased their involvement in postoperative rehabilitation. With the widespread application of such technologies, data security and privacy protection have become critical issues. Many mental health services are delivered through mobile health systems; however, the risk to data privacy is increasing because of security vulnerabilities. A study has reported that many mental health apps have problems such as unnecessary permission requests, insecure encryption implementations, and personal data leaks, all of which can lead to leakage and misuse of user privacy[47].

Although remote monitoring technologies can theoretically provide better patient management and support, there are still many challenges to their practical application. For example, ensuring the integration of these technologies with existing health technology infrastructure and addressing legal and security concerns are urgent issues to be resolved[48]. Additionally, attention should be paid to the patients' acceptance of and willingness to use digital health tools. Surveys can be conducted to analyze the factors influencing patient acceptance, such as technical complexity, privacy concerns, and device accessibility, providing evidence for the promotion and application of digital health tools. Furthermore, research on the integration of digital health tools with traditional psychological support methods should be strengthened to explore synergistic models.

CONCLUSION

This review comprehensively examined the current status and effects of psychological support in patients undergoing cardiac surgery during the perioperative period. Psychological interventions such as preoperative education, mindfulness, and cognitive training significantly enhanced postoperative recovery and mental health. However, there is scope for further improvement.

Perioperative psychological support for patients undergoing cardiac surgery often faces significant gaps, primarily because of fragmented measures and a lack of cross-stage integration. This fragmentation is evident in the disconnect between preoperative and postoperative interventions, which leads to inconsistent care and support for patients as they transition through different stages of their surgical journey. Lee et al[36] compared 49 patients undergoing cardiac surgery who received psychoeducational interventions with 46 who received standard care and reported a significantly lower incidence of postoperative delirium in the intervention group (12.24% vs 34.78%, P = 0.009). This study indicates that fragmented psychological support may increase the risk of postoperative delirium, as preoperative or intraoperative fear or stress boosts serum cortisol levels, which are associated with a higher risk of postoperative delirium. Zhao et al[40] reported that patients undergoing cardiac surgery often experience anxiety and depression after discharge due to poorly managed psychological stress, leading to a decline in their postoperative QoL. Moreover, the notable absence of standardized psychological post-discharge follow-up processes leaves patients without the necessary support to effectively manage their mental health after departing from the hospital. This gap in continuity of care adversely affects patient outcomes, as the psychological well-being of patients is crucial for their overall recovery and QoL after surgery. Additionally, insufficient nursing training exacerbates gaps in psychological support. Nurses play a critical role in the perioperative care of patients undergoing cardiac surgery, and their ability to provide effective psychological support depends on adequate training. Without comprehensive training programs that equip nurses with the skills to address the psychological needs of patients, the quality of care can be compromised. This lack of training results in nurses being ill-prepared to identify and manage psychological distress in patients, which is essential for promoting better recovery outcomes and enhancing patient satisfaction[49–51].

To address these challenges, it is imperative to develop integrated and standardized psychological support programs that span the perioperative period. Such programs should ensure a seamless transition between preoperative and postoperative care, with continuous psychological follow-up after discharge. Additionally, enhancing nursing education and training to focus on psychological care will empower nurses to provide holistic and effective support for patients undergoing cardiac surgery. By addressing these gaps, healthcare providers can improve the overall quality of care and support the psychological well-being of patients undergoing cardiac surgery.

An important direction for the development of psychological support during the perioperative period for patients undergoing cardiac surgery is the creation of standardized psychological support care pathways. These pathways must consider the patient’s physiological needs, mental health, and emotional support. Previous research has shown that psychological care plays a crucial role in the rehabilitation of patients undergoing cardiac surgery. By conducting psychological assessments and providing graded care, postoperative emotional states and sleep quality significantly improved, enhancing care efficiency and reducing negative emotions[52].

Strengthening multidisciplinary collaboration is key to perioperative care. Multidisciplinary teams, including psychologists, nurses, and rehabilitation therapists, worked together to optimize postoperative recovery. This teamwork meets patients’ physical and psychological needs and provides comprehensive care[53]. For example, collaborative models improve clinical outcomes and reduce postoperative complications in cardiothoracic surgery[50]. Psychologists play an important role in these teams, as they help patients manage the psychological stress associated with surgery and develop personalized support plans to promote overall recovery. This allows patients to receive better postoperative psychological support, thereby improving their QoL and recovery[54].

Recent research has revealed the potential for perioperative care in the realm of digital therapeutics, particularly with the application of technologies such as VR relaxation training and artificial intelligence-based emotion monitoring. Bibliometric analysis indicated growing attention to VR technology in preoperative anxiety research, particularly in pediatric patients[55]. These technologies help patients better manage preoperative anxiety and provide ongoing emotional support during postoperative recovery, potentially revolutionizing psychological support delivery; however, their feasibility requires validation through large-scale clinical studies.