Does increased preoperative education for patients undergoing external fixation improve overall satisfaction?

To determine if increased preoperative education on how to manage activities of daily living with a lower extremity external fixator would improve overall patient satisfaction.

Design: Prospective cohort, randomized, double-blinded study.

Level I academic trauma center. Patient Selection Criteria: Patients were prospectively identified for enrollment before undergoing external fixation. Adult patients with any lower extremity fracture requiring placement of a knee or ankle external fixator were included. Exclusion criteria consisted of skeletally immature patients, those with a history of external fixation, altered mental status, or placement of multiple external fixators. Patients were randomized via a stratified block method and were blinded as to whether they had received the preoperative educational intervention. Outcome Measures and Comparisons: Patient satisfaction was determined using a validated modified Leeds Satisfaction Questionnaire distributed at two time points: (1) on postoperative day one or two (Survey A) and (2) after external fixation at a follow-up appointment (Survey B). Patient questionnaires were distributed and collected by a research investigator blinded to the participant's intervention status.

A total of 89 patients were included in the analysis. Only one survey question demonstrated a statistically significant difference between the control and intervention groups, with the control group reporting a more favorable response. However, the intervention group consistently exhibited higher minimum scores across all question domains in both surveys. Female patients, individuals with a history of smoking or substance use, and those with open fractures reported significantly lower scores across multiple survey items. Hispanic patients reported greater satisfaction across eight questions and three domains in Survey A.

Enhanced preoperative education did not lead to a statistically significant improvement in overall patient satisfaction. However, its potential to reduce dissatisfaction and elevate minimum response scores suggests that it may still provide clinically meaningful benefits.