Patient Comprehension of Foot and Ankle Surgery

Abstract

Category: Other Introduction/Purpose: Health literacy represents a set of individual abilities which allow patients to assimilate information that helps them comprehend their medical condition and any interventions available for remedy. The purpose of this investigation was to determine the percentage of patients who— after undergoing the process of informed consent and being provided a postoperative instruction document—were then able to reach an elementary understanding of the pathology and requisite care associated with open reduction internal fixation of an ankle or foot fracture, osteotomy, fusion, or arthroscopy, including perioperative complications. Methods: Any patient who elected to have a foot or ankle surgical procedure that involved fracture, fusion, osteotomy, or arthroscopic management was recruited to participate in the study. Patients who were not deemed fluent in English were excluded. All patients were told that they would be asked to complete a questionnaire about their surgery and post-operative instructions. Enrolled patients were informed about the care and potential postoperative complications associated with their particular procedure during the informed consent process at the preoperative visit. All answers to each question of the questionnaire they would later receive were verbally given to each patient during this visit, and they were also given a post- operative instruction sheet that contained written answers to all these questions as well. At their first post-operative visit and prior to seeing the physician, all patients were then asked to complete this multiple choice questionnaire. The questionnaire was subsequently reviewed by the clinician with each patient at the end of this postoperative visit. Results: Forty-one patients were enrolled prospectively. Ninety percent (n=37) reported that they had read the postoperative instructions, and 92.7% (n=38) reported that they preferred a written handout versus a verbal, video, or on-line instructional alternative.. The average percentage of correct answers was 72.3% (7.95 out of 11 correct SD 1.4, 95% CI, 7.52 to 8.38). Only 43.9% (n=18) knew the correct response to ‘When can I return to driving an automatic vehicle?’. Only 53.7% (n=22) of patients knew ‘What is an appropriate protocol for icing immediately after surgery’. Chi square analysis of correct response count revealed no significant difference between patients with a high school versus higher level of education (p=0.22), males versus females (p=0.98), or age 18 to 30 versus over 30 years (p=0.59). Conclusion: Although we made significant pre-operative oral and written efforts to help patients achieve an elementary level of health literacy regarding their forthcoming foot or ankle surgery, we found that many continued to lack a baseline level of acceptable comprehension regarding numerous pertinent components of perioperative care and outcome. Because the results are concerning, we plan to next implement and test an alternative video aide to assess whether alternative forms of communication will increase comprehension and retention of surgical foot and ankle patients.