Elective orthopedic surgeries such as total hip and knee arthroplasties, spinal procedures, and arthroscopic interventions are increasingly performed worldwide to improve mobility, reduce pain, and enhance quality of life in patients with degenerative or traumatic musculoskeletal disorders. With the growing number of such procedures, emphasis has shifted beyond surgical technique to include holistic patient-centered care, where psychological preparedness and patient education are emerging as pivotal components of perioperative management [1].

Preoperative education programmes are structured interventions designed to inform patients about the surgical procedure, anesthesia, pain management, postoperative recovery, rehabilitation, and expected outcomes. These programmes may include verbal instructions, written materials, multimedia presentations, group classes, or individualized counseling sessions. The goal is to reduce preoperative anxiety, improve patient understanding and compliance, and ultimately enhance satisfaction and surgical recovery [2,3]. The Joint Commission and other international health bodies recognize preoperative education as a best practice in surgical care pathways [4].

Multiple studies have documented the psychological and clinical benefits of preoperative education. Improved understanding of the surgical process helps reduce patient fear, sets realistic expectations, and fosters a sense of control and involvement in care decisions [5]. This psychological readiness is especially crucial in orthopedic procedures, where postoperative rehabilitation and patient cooperation are essential for optimal outcomes. Patients who are well-informed are more likely to adhere to physiotherapy protocols, report lower levels of postoperative pain, and experience reduced hospital stays and complications [6].

Furthermore, patient satisfaction—a key quality indicator in modern healthcare—is significantly influenced by preoperative education. Satisfied patients are more engaged in their care, demonstrate better treatment adherence, and are less likely to pursue litigation or file complaints [7]. In orthopedic settings, where expectations are high and recovery is often prolonged, clear communication through preoperative education can mitigate dissatisfaction arising from unmet expectations or misunderstandings [8].

Despite the recognized benefits, the implementation of preoperative education varies across institutions in terms of content, duration, format, and the personnel involved. Some centres offer comprehensive multidisciplinary sessions, while others provide minimal or inconsistent information. Additionally, the impact of these programmes on objective surgical outcomes such as complication rates, length of hospital stay, and readmission rates remains inadequately studied in certain contexts [9]. There is also a lack of standardized evaluation tools to measure the effectiveness of educational interventions in relation to patient satisfaction and recovery metrics.

In India and other developing countries, the integration of structured preoperative education into routine orthopedic practice is still evolving. Cultural, linguistic, and literacy barriers may influence the delivery and effectiveness of such programmes. Therefore, context-specific research is needed to assess the role of preoperative education in improving outcomes for orthopedic patients in diverse settings [10].

This original research aims to evaluate the effectiveness of preoperative education programmes on patient satisfaction and surgical outcomes in elective orthopedic surgeries. By analyzing both subjective (satisfaction scores) and objective (clinical outcomes) parameters, the study intends to provide evidence-based insights for enhancing perioperative care protocols

Study Design and Setting

This prospective observational study was conducted in the Department of Orthopedics at a tertiary care hospital. Institutional Ethical Committee approval was obtained prior to initiating the study, and written informed consent was taken from all participants.

 Study Population

A total of 100 patients scheduled for elective orthopedic surgeries, including total knee replacement, total hip replacement, and spinal surgeries, were enrolled in the study. Patients aged between 30 and 75 years, of both genders, and willing to participate in the preoperative education programme were included. Patients undergoing emergency surgery, those with cognitive impairment, psychiatric illness, or language barriers that hinder comprehension of the educational material were excluded.

 Grouping

Patients were divided into two groups of 50 each:

• Group A (Intervention Group): Received a structured preoperative education programme.
• Group B (Control Group): Received routine preoperative instructions only.

 Preoperative Education Programme

The intervention for Group A included:

• A 30-minute interactive session conducted two days prior to surgery by a multidisciplinary team including an orthopedic surgeon, anesthesiologist, and physiotherapist.
• Information provided through audiovisual aids and printed brochures in the local language.
• Content included details on the surgical procedure, type of anesthesia, expected intraoperative and postoperative course, pain management, physiotherapy, and discharge instructions.

 Data Collection Tools

• Patient Satisfaction was assessed using a validated 10-point Likert scale administered postoperatively on Day 3.
• Anxiety Levels were measured preoperatively using the State-Trait Anxiety Inventory (STAI).
• Surgical Outcomes included:
• Length of hospital stay (in days)
• Postoperative pain scores using the Visual Analog Scale (VAS)
• Time to mobilization (in hours)
• Occurrence of complications (wound infections, thromboembolic events)

 Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 25.0. Continuous variables were presented as mean ± standard deviation, and categorical variables as frequency and percentages. The independent t-test was used for comparing means between the two groups, and the chi-square test for categorical variables. A p-value < 0.05 was considered statistically significant.

The demographic characteristics of the study population showed no statistically significant differences between the two groups. The mean age of participants in Group A was 58.4 ± 8.2 years, while in Group B it was 59.1 ± 7.6 years (p = 0.63). Both groups had a nearly equal gender distribution and similar proportions of patients undergoing total knee replacement, total hip replacement, and spinal surgery, ensuring comparability between groups [Table 1].

Assessment of preoperative anxiety using the State-Trait Anxiety Inventory (STAI) revealed significantly lower anxiety levels in patients who received the structured preoperative education. Group A had a mean STAI score of 28.2 ± 5.6, while Group B showed a considerably higher score of 35.4 ± 6.1, indicating a statistically significant reduction in anxiety levels in the intervention group (p < 0.001) [Table 2].

Postoperative surgical outcomes showed substantial improvements in Group A compared to Group B. Patients in the education group reported significantly lower pain scores (4.1 ± 1.2 vs. 5.6 ± 1.4, p < 0.001), earlier mobilization times (22.3 ± 5.1 hours vs. 28.6 ± 6.2 hours, p < 0.001), and shorter hospital stays (4.8 ± 1.3 days vs. 6.2 ± 1.7 days, p < 0.001). Although the complication rate was lower in Group A (4%) compared to Group B (12%), this difference did not reach statistical significance (p = 0.14) [Table 3].

Patient satisfaction measured on the third postoperative day using a 10-point Likert scale showed significantly higher satisfaction among patients who received preoperative education. In Group A, 84% of patients reported high satisfaction (scores of 8–10), compared to 52% in Group B. The mean satisfaction score was also significantly higher in Group A (8.6 ± 1.1) than in Group B (6.7 ± 1.6), with a p-value of < 0.001, indicating a strong positive impact of education programmes on patient-perceived care quality [Table 4].

Table 1: Demographic Distribution of Study Participants

Note: TKR = Total Knee Replacement, THR = Total Hip Replacement

 Table 2: Comparison of Anxiety Scores (Preoperative)

Note: Lower STAI scores indicate reduced anxiety. Significant difference observed post-education.

 Table 3: Postoperative Surgical Outcomes

 Table 4: Patient Satisfaction Scores (Postoperative Day 3)

Preoperative education has emerged as a crucial component in enhancing perioperative care and improving surgical outcomes in elective orthopedic procedures. The present study demonstrated that a structured, multidisciplinary preoperative education programme significantly reduced patient anxiety, improved postoperative recovery, and enhanced patient satisfaction among individuals undergoing elective orthopedic surgeries. These findings align with previous research that has emphasized the multifactorial benefits of patient-centered educational interventions in surgical care [6].

One of the most striking outcomes observed in this study was the reduction in preoperative anxiety levels among patients in the intervention group. Anxiety is a common emotional response to surgery and can adversely affect physiological responses, pain perception, and postoperative recovery [7]. Providing patients with detailed information about the surgical procedure, anesthesia, rehabilitation, and postoperative expectations helps alleviate fear of the unknown and fosters a sense of preparedness. A study by Lin et al. found that anxiety levels were significantly lower in patients who received structured preoperative education before joint replacement surgery [8]. Our results support these findings, with a significant difference in mean STAI scores between the groups (p < 0.001).

The role of preoperative education in improving objective clinical outcomes such as pain levels, time to mobilization, and duration of hospitalization is increasingly recognized. In the current study, patients in the education group reported significantly lower postoperative pain scores. This may be attributed to the enhanced understanding of pain management strategies provided during the education session, including the use of analgesics, physiotherapy, and breathing techniques. According to Johansson et al., well-informed patients often have better pain tolerance and coping strategies, leading to reduced postoperative discomfort [9]. Moreover, early mobilization, which is critical in orthopedic recovery, was achieved faster in the intervention group, likely due to improved adherence to physiotherapy protocols and reduced fear of movement.

Length of hospital stay is another crucial parameter in evaluating surgical outcomes and healthcare resource utilization. Our findings revealed that patients who received preoperative education were discharged significantly earlier than those in the control group. This supports the work of Wang et al., who reported a similar reduction in hospital stay among patients undergoing total knee arthroplasty who had received comprehensive preoperative counseling [10]. The reduction in hospitalization not only benefits patient outcomes but also has significant implications for cost-effectiveness and hospital bed management.

Although the difference in complication rates between the two groups was not statistically significant, there was a trend toward fewer complications in the education group. This observation is consistent with prior literature suggesting that preoperative counseling may reduce postoperative complications through better compliance with instructions, early recognition of adverse signs, and reduced physiological stress [11]. However, a larger sample size may be necessary to detect statistically significant differences in rare adverse outcomes.

Perhaps the most compelling evidence of the effectiveness of preoperative education is reflected in patient satisfaction scores. In our study, 84% of patients in the intervention group reported high satisfaction, compared to 52% in the control group. Patient satisfaction is not only an indicator of service quality but also correlates with better health outcomes, adherence to treatment, and lower risk of complaints or litigation [12]. Preoperative education empowers patients by involving them in the decision-making process, setting realistic expectations, and reducing the likelihood of dissatisfaction due to unmet expectations. A study by McDonald et al. emphasized that communication and patient involvement are pivotal to positive surgical experiences [13].

Furthermore, cultural and contextual factors play a significant role in the effectiveness of educational interventions. In developing countries like India, where literacy levels and access to health information may be limited, structured education tailored to local languages and cultural sensitivities can bridge the information gap. Interactive and multimedia tools enhance understanding, particularly for patients with low health literacy [14]. Our study used printed and audiovisual materials in the regional language, which may have contributed to the favourable outcomes observed.

Despite the positive findings, this study has certain limitations. The sample size was modest and limited to a single institution, which may affect the generalizability of the results. Additionally, long-term outcomes such as functional recovery and readmission rates were not assessed. Future research should focus on multicentric trials with larger populations and evaluate the long-term effects of preoperative education on quality of life and functional independence.

Nonetheless, the evidence presented here reinforces the importance of incorporating structured preoperative education into routine orthopedic surgical care. As supported by systematic reviews and clinical guidelines, educational interventions must be standardized and integrated into enhanced recovery protocols to improve surgical outcomes and patient experiences [15].

This study highlights the significant positive impact of structured preoperative education programmes on reducing anxiety, enhancing postoperative recovery, and improving patient satisfaction in elective orthopedic surgeries. Patients who received education experienced lower pain, faster mobilization, shorter hospital stays, and higher satisfaction levels. These findings support the integration of patient-centered educational interventions into standard surgical care to optimize outcomes, promote informed decision-making, and improve the overall quality of perioperative management. Future large-scale studies are warranted to further validate these findings across diverse populations and surgical specialties.

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