Effect of Preoperative Instructions on Post Operative Outcome Measures among Patients Undergoing Abdominal Surgeries in a Tertiary Care Hospital at Ernakulum District

 

Jesmy Sam

Lecturer, Department of Medical Surgical Nursing, M.O.S.C College of Nursing, Kolenchery, Kerala, India.

*Corresponding Author E-mail: jesmysam@gmail.com

 

ABSTRACT:

Background: Until the industrial revolution, surgeons were incapable of overcoming the three principal obstacles which had plagued the medical profession from its infancy — bleeding, pain and infection. Advances in these fields have transformed surgery from a risky "art" into a scientific discipline capable of treating many diseases and conditions. Objectives: To assess the level of knowledge regarding preoperative preparation measures among patients undergoing general abdominal surgery before and after intervention. To evaluate the effect of preoperative instructions on post operative outcome measures among patients undergoing abdominal surgeries. To find out the association between the level of knowledge and selected socio personal variables of patients undergoing abdominal surgeries. Methods: A quantitative, quasi-experimental pre-test post-test control group design was adopted. Sixty patients undergoing abdominal surgeries were selected using non-probability convenience sampling and divided into experimental (n=30) and control (n=30) groups. Tools included a socio-personal data sheet, a 30-item knowledge questionnaire, and a postoperative outcome checklist. Preoperative instructions were given to the experimental group via lectures and demonstrations. Data were collected over seven days, with postoperative outcomes assessed over five days. Validity and reliability were ensured by expert review and the split-half method. Data were analyzed using descriptive and inferential statistics. Results: Post-test knowledge scores improved significantly in the experimental group (mean increased from 16.6 to 24.8; t = 13.66, p < 0.05). Patients receiving preoperative instructions showed better postoperative outcomes in vital signs, wound healing, pain management, and ambulation compared to the control group. Conclusion: Preoperative instructions significantly improved knowledge and enhanced postoperative recovery outcomes. Structured patient education before surgery is essential in promoting optimal recovery.

 

KEYWORDS: Preoperative instructions, postoperative outcomes, abdominal surgery, patient education, knowledge improvement, surgical recovery.

 

 

 

 

 

 

 

INTRODUCTION:

Surgery is the branch of medicine that deals with physical manipulation of bodily structures to diagnose, prevent, or cure an ailment6. Ambroise Pare, a 16th-century French surgeon, famously described surgery as “to eliminate that which is superfluous, restore that which has been dislocated, separate that which has been united, join that which has been divided, and repair the defects of nature”8. In India, the Sushruta Samhita is credited to Sushruta, often referred to as the “Father of Surgery”10. Billroth is considered the father of abdominal surgery9.

 

Until the industrial revolution, surgery was severely limited by the challenges of bleeding, pain, and infection9. The evolution of anesthesia, antisepsis, and surgical techniques has since transformed surgery into a safe and scientific practice6. According to Haggard (1989), patient education is integral to modern healthcare and essential for self-care and positive surgical outcomes7.

 

OBJECTIVES:

·       To assess the level of knowledge regarding preoperative preparation measures among patients undergoing general abdominal surgery before and after intervention.

·       To evaluate the effect of preoperative instructions on post operative outcome measures among patients undergoing abdominal surgeries.

·       To find out the association between the level of knowledge and selected socio personal variables of patients undergoing abdominal surgeries.

 

HYPOTHESIS:

H1: There is a significant difference in the mean pre-test and post test knowledge scores among control and experimental group.

H2: There is a significant association between pre test knowledge score of patients undergoing abdominal surgery and their selected socio personal variables

 

MATERIALS AND METHODS:

Research Approach: Quantitative research approach

 

Research design: Quantitative research design (Quasi experimental pre-test post-test control group design).

 

Research variables:

Independent Variable: Preoperative instructions provided to patients undergoing abdominal surgeries.

 

Dependent Variables: Knowledge level of patients regarding preoperative preparation, Postoperative outcome measures, including vital signs, wound healing, pain, infection rate, and early ambulation

 

Setting of the study: The study was conducted in a tertiary care hospital of Ernakulum district, Kerala.

 

 

Population: patients undergoing general abdominal surgery.

 

Sample and Sampling Technique:

Sample: 60 patients undergoing general abdominal surgeries in a tertiary care Hospital, Ernakulam (30 each in control and experimental group).

 

Sampling Technique: Non-Probability Convenience Sampling Technique

 

Sample size: 60.

 

Sample selection criteria:

Inclusion criteria:

·       Patients who are admitted for elective abdominal surgery.

·       Patients who are willing to participate in this study.

·       Patients who need a minimum of 5 days hospital admission after surgery.

·       Patients, who are able to read, write and communicate, coming under the age group 20 – 60 years.

 

Exclusion criteria:

·       Patients who are admitted for emergency surgeries.

·       Patients who are unconscious.

·       Patients who are not able to read and write Malayalam or English.

 

Data Collection tools:

The data collection tools used in this study included a socio-personal data sheet, a knowledge questionnaire, and a postoperative outcome checklist. The socio-personal data sheet gathered demographic and background information such as age, gender, education, marital status, and previous surgical history. The knowledge questionnaire, consisting of 30 multiple-choice questions, assessed the patients’ understanding of preoperative instructions, including surgical preparation, postoperative care, and exercises. To evaluate the effectiveness of the intervention, a postoperative outcome checklist was used to monitor vital signs, pain levels, wound healing, catheter and drain site conditions, and early ambulation. These tools were developed based on literature review and expert input, validated for content accuracy, and tested for reliability before being applied in the main study.

 

RESULTS:

Section I: Baseline Characteristics of the Sample

Sl. No.

Variable

Category

Experimental Group (n=30)

Control Group (n=30)

Total (N=60)

1

Age (in years)

20–30

8

7

15

31–40

10

9

19

41–50

7

8

15

51–60

5

6

11

2

Sex

Male

17

15

32

Female

13

15

28

3

Marital Status

Married

24

25

49

Unmarried

6

5

11

4

Education

Primary

6

5

11

Secondary

10

12

22

Higher Secondary

8

7

15

Graduate and above

6

6

12

5

Occupation

Employed

14

13

27

Unemployed

16

17

33

6

Type of Family

Nuclear

18

20

38

Joint

12

10

22

7

Previous Surgery History

Yes

10

11

21

No

20

19

39

8

Prior Info on Surgery

Yes

12

11

23

No

18

19

37

 

 

Section II: Effectiveness of preoperative instructions on the level of knowledge and postoperative outcome measures among patients undergoing general abdominal surgeries

Parameter

Group

Mean ± SD

t-value

p-value

Interpretation

Knowledge Score (Pretest)

Experimental

16.6 ± 2.4

0.72

> 0.05

Not significant

Control

16.1 ± 2.8

Knowledge Score (Posttest)

Experimental

24.8 ± 2.1

13.66

< 0.05

Significant

Control

17.2 ± 3.0

Postoperative Vital Signs

Experimental

Stable in most cases

2.42

< 0.05

Significant

Control

Less stable

Wound Healing

Experimental

Faster healing

2.15

< 0.05

Significant

Control

Delayed healing

Pain Level (Lower score = better)

Experimental

3.2 ± 1.1

4.56

< 0.05

Significant

Control

5.6 ± 1.3

Early Ambulation (in days)

Experimental

2.3 ± 0.8

5.12

< 0.05

Significant

Control

4.1 ± 1.0

 

Section III: Association of Mean Pre Test Level of Knowledge of Patients Undergoing Abdominal Surgeries with Selected Socio Personnel Variables.

There was a statistically significant association between the pretest knowledge level and variables such as education level, previous surgical history, and prior information on surgery. However, no significant association was found with age, gender, or marital status.

 

MAJOR FINDINGS:

The study revealed that preoperative instructions significantly improved the knowledge and postoperative outcomes of patients undergoing abdominal surgeries. In the pretest, most participants in both groups had average knowledge, with none scoring in the excellent range. However, after the intervention, 53.33% of the experimental group achieved excellent knowledge scores, while no such improvement was observed in the control group. The experimental group also demonstrated significantly better postoperative outcomes, including more stable vital signs, faster wound healing, lower pain levels, and earlier ambulation. Statistical analysis confirmed that these differences were significant (p < 0.05), indicating the effectiveness of the intervention. Additionally, the study found that education level, previous surgical history, and prior information about surgery were significantly associated with higher pretest knowledge scores, whereas age, gender, and marital status showed no significant association.

 

DISCUSSION:

This study aligns with findings from previous literature. Haggard emphasized the importance of patient education for promoting self-care7. Similar results were found in studies that reported preoperative teaching improves pain control, mobility, and satisfaction634. Research by Good et al. (2010) also confirmed improved postoperative outcomes from patient education interventions like music, relaxation, and teaching35. Preoperative instructions significantly reduced pain, improved vital signs, wound healing, and accelerated recovery.1633

 

ACKNOWLEDGEMENT:

Here we extend our sincere thanks to all people who participated in the study.

 

CONFLICT OF INTEREST:

The author declares no conflict of interest in the study.

 

REFERENCES

1.        Polit FD, Hungler. Nursing Research: Principles and Methods. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 1999.

2.        The Concise Oxford Dictionary (10th ed.). New Delhi: Oxford University Press; 1999.

3.        Polit FD, Beck TC. Essentials of Nursing Research – Methods, Appraisal and Utilization. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.

4.        Sharma KS. Nursing Research and Statistics. Haryana: Elsevier; 2011.

5.        Basavanthappa BT. Nursing Research. 2nd ed. New Delhi: Jaypee Publishers; 2007.

6.        Black MJ, Hawks HJ. Medical Surgical Nursing. 5th ed. Missouri: Mosby Elsevier; 2009.

7.        Haggard LM. Patient Education: A Practical Approach. C.V. Mosby Company; 1989.

8.        Pare A. Quoted in Ellis H. A History of Surgery. Greenwich Medical Media.

9.        Billroth T. Referenced in Rutkow IM. Surgery: An Illustrated History. Elsevier Science; 2004.

10.      Sushruta. Sushruta Samhita. Referenced in: Dwivedi G, Dwivedi S. Indian J Chest Dis Allied Sci. 2007; 49: 243–244.

 

 

 

 

 

Received on 10.06.2025         Revised on 07.08.2025

Accepted on 17.09.2025         Published on 03.11.2025

Available online from November 12, 2025

A and V Pub J. of Nursing and Medical Res. 2025;4(4):121-124.

DOI: 10.52711/jnmr.2025.27

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