Preoperative Educational Counseling: A Key to Improve Patient Satisfaction and Outcome in Neurosurgical Care

Abstract

Background

Preoperative education is increasingly acknowledged as a cornerstone in improving surgical outcomes and patient satisfaction, particularly in high-risk specialties such as neurosurgery. Our study aims to assess the effects of preoperative education on patient satisfaction and outcomes in a neurosurgical procedure at our tertiary care center in India.

Materials and Methods

A prospective observational study was conducted over 6 months, involving 96 adult patients undergoing elective neurosurgical procedures. Participants were divided into an intervention group, receiving a 45-minute structured preoperative education session, and a control group, receiving only verbal counseling without the additional structured educational session. Patient satisfaction was measured postoperatively, and clinical outcomes, including hospital stay duration, recovery times, and complication rates, were analyzed.

Results

Patients in the intervention group reported higher satisfaction scores and demonstrated shorter hospital stays. While the reduction in postoperative complications was not statistically significant, a downward trend was observed. Preoperative education emerged as a significant predictor of high satisfaction.

Conclusion

Comprehensive preoperative education in neurosurgery effectively reduces patient anxiety, enhances satisfaction, and facilitates faster recovery. Implementing structured, standardized educational programs is a cost-efficient approach to addressing misconceptions and improving outcomes, particularly in neurosurgery, where the complexity and perceived risks of brain and spinal surgeries often intensify patient concerns. Adopting this strategy in our practice will significantly contribute to delivering high-quality health care.

Keywords

preoperative education - patient satisfaction - neurosurgery - anxiety reduction - clinical outcomes - recovery time

Introduction

Preoperative education plays a vital role in enhancing patient outcome and satisfaction in surgical care, particularly in neurosurgery. Given the complex nature and potential risks associated with neurosurgical procedures, it is essential to ensure that patients are thoroughly informed about their treatment process. Though an essential aspect of preoperative care, traditional verbal counseling often fails to clarify patient misconceptions regarding their illnesses and treatments.[1] [2] Research indicates that preoperative education helps reduce anxiety, improve patient compliance, and enhance overall satisfaction with the surgical experience.[3] Additionally, informed patients tend to develop realistic expectations about their treatment outcomes, contributing to better recovery and overall results.[4] Our study aims to assess the effects of preoperative education on patient satisfaction and outcomes in a neurosurgical procedure at our tertiary care center in India. This research examines the relationship between preoperative education and surgical outcomes, aiming to strengthen the evidence for integrating structured educational programs into neurosurgical care. The insights obtained are anticipated to improve patient care and to raise the quality of neurosurgical services in neurosurgical tertiary centers.

Materials and Methods

Study Design and Participants

A 6-month prospective observational study was conducted at the Department of Neurosurgery, MGM Super Specialty Hospital, Indore, Madhya Pradesh from January 1, 2024, to June 30, 2024. Ninety-six adult patients scheduled for elective neurosurgical procedures were included in the study.

Inclusion Criteria

• Patients of all age groups undergoing elective cranial and spinal surgeries are included.

Exclusion Criteria

The exclusion criteria are as follows:

• Patients undergoing emergency surgeries.

• Cognitive impairments or severe psychiatric conditions.

Participants in the study were divided into two groups: (1) the intervention group and (2) the control group. The intervention group received structured preoperative educational counseling, while the control group received standard preoperative care without additional educational support.

Preoperative Education Program in Intervention Group

The intervention group attended a 45-minute educational session, the day before surgery. Our medical team, including junior residents, senior residents, and junior consultants, performed this session. This session included a detailed explanation of the surgical procedure, anesthesia, and potential postoperative complications. Visual aids, such as videos on a laptop/tablet/mobile and diagrams drawn on a board, were used to enhance understanding. Following the presentation, a brief question-and-answer segment allowed patients to ask any questions they had about the procedure.

Control Group

In contrast, the control group received standard care, which involved a brief verbal explanation from the attending physician without the additional structured educational session.

Outcome Measures

• Patient Satisfaction: Measured 72 hours postoperatively using a questionnaire that covered various aspects of the surgical experience, including preoperative understanding, communication with health care providers, anxiety levels, and overall satisfaction with care.

• Clinical Outcomes: Length of hospital stay, recovery times, and postoperative complications were recorded.

Recovery time in our study was defined by combining parameters, including length of hospital stay, complications, cognitive function assessment by Folstein minimental state examination, neurobehavioral skills, and emotional or well-being status, with the help of a psychiatrist and psychocounselors in both the interventional and control groups.

Data Analysis

Our data were analyzed by using SPSS (version 27.0). Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Comparisons between the intervention and control groups were made using the chi-square test for categorical variables and the independent t-test for continuous variables. A p-value of <0.05 was considered statistically significant. Logistic regression analysis was performed to identify independent predictors of patient satisfaction and improved clinical outcomes.

Informed consent was obtained from all participants prior to their inclusion in the study. Participants were assured of the confidentiality of their data, and they had the right to withdraw from the study at any time without any impact on their clinical care. Statistical analysis included independent t-tests, chi-square tests, and logistic regression to assess the impact of education on patient satisfaction and outcomes.

Results

A total of 96 patients were included in the study. The final sample size was calculated using the following formula for determining sample size for comparing two independent means:

n = 2 × (Zα/2 + Zβ) 2 × σ2Δ2n = Δ22 × (Zα/2 + Zβ) 2 × σ2,

where

• nn = required sample size per group

• Zα/2Zα/2 = Z value for a 95% confidence level (1.96)

• ZßZβ = Z value for 80% power (0.84)

• σσ = estimated standard deviation (assumed to be 10 based on previous studies)

• ΔΔ = minimum detectable difference (assumed to be 5).

Given these assumptions, the calculated sample size was 48 patients each in the intervention and control groups.

Age and Sex Distribution

We found that the mean age of distribution in the intervention group in our study was 54.2 ± 11.6 years, while in the control group, the mean age of distribution was 50.5 ± 9.7 years. There was no significant difference in the groups (p > 0.05), as shown in [Table 1].

Table 1 Distribution of patients in the intervention and control groups based on demography, neurosurgical procedure, and baseline anxiety score

Characteristic	Intervention group (n = 48)	Control group (n = 48)	p-Value
Mean age (y)	54 ± 11.6	50.5 ± 9.7	0.80
Gender (male/female)	29/19	27/21	0.88
Type of surgery
Craniotomy	22	22	0.71
Spinal surgery	16	19	0.78
Others	10	7	0.77
Baseline anxiety score	6.6 ± 1.9	5.7 ± 2.2	0.89

Type of Neurosurgical Procedure Performed

Out of 48 patients in the intervention group, 22 patients underwent cranial surgeries,16 underwent spinal surgeries, and the rest 10 underwent other procedures which include mostly cases of peripheral nerve surgeries. In the control group, out of 48 patients, 22 underwent craniotomy,19 underwent spinal surgery, and in the rest 7, other procedures were performed. When all these procedures were compared in both groups, no statistically significant difference was found (as shown in [Table 1])

Comparing the Baseline Anxiety Score before Preoperative Counseling

No statistical difference was found when comparing the baseline anxiety scores between the interventional group (6.6 ± 1.9) and the control group (5.7 ± 2.2), as shown in [Table 1]. This comparison was made prior to preoperative counseling related to the type of neurological procedure being performed on the patients.

Comparison of Patient Satisfaction Parameters after Preoperative Counseling in Both Groups

The satisfaction parameters (as shown in [Table 2] and [Fig. 1]), which included overall satisfaction, understanding of the procedure, confidence in the medical team, and preoperative anxiety level after preoperative counseling were scored from 0 to 10 on a scale, and these parameters were compared in both the groups. It was found that in the intervention group, overall satisfaction parameters in patients were more as compared with the control group, and the results were statistically significant. The intervention group reported a better understanding of the surgical procedure, higher confidence in the medical team, and lower anxiety levels preoperatively.

Table 2 Patient satisfaction score after preoperative counseling in both the groups

Satisfaction parameter	Intervention group (n = 48)	Control group (n = 48)	p-Value
Overall satisfaction score (0–10)	8.7 ± 0.7	7.3 ± 1.1	< 0.001
Understanding of procedure	9.1 ± 0.7	7.6 ± 1.0	< 0.001
Confidence in medical team	9.1 ± 1.0	7.3 ± 1.5	< 0.001
Preoperative anxiety level	5.5 ± 1.0	6.5 ± 1.5	< 0.001

Fig. 1 Comparison of satisfaction parameters between groups.

Postoperative Hospital Stay and Recovery

The intervention group experienced shorter hospital stay of 4.3 ± 1.2 days versus 5.7 ± 1.5 days in the control group and the results were statically significant (p = 0.02), and faster recovery times in the intervention group was 3.6 ± 0.8 days versus (4.9 ± 1.1) days in the control group and the results were statistically significant (p = 0.01).

Complications

A lower incidence of complications was noted in the intervention group (10%) versus 21% in the control group, but the difference was not statistically significant (p < 0.05).

Discussion

Our study highlights the pivotal role of preoperative education in neurosurgery. We observed that satisfaction parameters—including overall satisfaction scores, understanding of the procedure, confidence in the medical team, and levels of preoperative anxiety—were significantly higher in the intervention group compared with the control group (as shown in [Table 2]). These results were statistically significant (p < 0.05). Our findings align with various other studies by Dicpinigaitis et al, Mitchell, and McDonald and Thomas[5] [6] [7] who also demonstrated in their study that patient educational interventions delivered through various modalities are widely applicable in neurosurgery and consistently enhance patient knowledge and satisfaction. So, these outcomes are particularly valuable in neurosurgery, where the complexity and perceived risks of brain and spinal surgeries often heighten patient anxiety. Lower anxiety levels can contribute to smoother surgical experiences, reduced need for sedatives, and even better pain management postoperatively.[8] [9] [10]

In our study, we also noted that patients in the intervention group, who received preoperative educational counseling, demonstrated significantly shorter postoperative hospital stays and faster recovery, compared with those of the control group who received only verbal counseling. Enhanced recovery and reduced hospital stay address these challenges, offering both physical and psychological benefits. Reduced hospital stays and accelerated recovery time in patients not only contribute to lower health care costs but also alleviate the strain on bed availability. This is particularly significant in tertiary care centers such as ours, where ensuring bed availability for the patients remains a persistent challenge.

When we compared the incidence of postoperative complications between the two groups, we found the overall complication rate was lower in the intervention group, though the difference did not reach statistical significance (p < 0.05).

We think that future studies should aim to design adaptable and scalable models of preoperative education tailored to the specific requirements and resources of various health care systems.

Conclusion

Effective preoperative educational counseling is vital for delivering high-quality health care, particularly in neurosurgery, where the complexity of procedures necessitates clear and accurate communication. While verbal counseling is commonly used in our routine practice, it often falls short in addressing patient misconceptions about their conditions and treatments. This can lead to unrealistic expectations, dissatisfaction, and suboptimal clinical outcomes. The lack of standardized and structured informed consent protocols in many health care settings further compounds these challenges. Thus, our study concludes that comprehensive preoperative education is essential for reducing patient anxiety and improving satisfaction levels in routine neurosurgical procedures. Recent advancements in educational methodologies and technologies provide promising opportunities to address these deficiencies. Structured preoperative education is a cost-effective strategy that not only enhances patient satisfaction but also promotes faster recovery. These findings underscore the importance of integrating structured educational programs into standard preoperative care protocols in neurosurgery.

Conflict of Interest

None declared.

Authors' Contributions

S.N. contributed to conceptualization, methodology, validation, formal analysis, investigations, resources, data curation, writing the original draft, writing the review and editing, supervision, project administration, and was a guarantor. P.A., P.L., and P.K.P. contributed to methodology, validation, formal analysis, investigations, resources, and writing review and editing.

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Publication History

Article published online:
17 June 2025