Best Practices for Postoperative Instructions
Effective postoperative instructions are essential for ensuring patient safety, reducing readmissions, and minimizing surgical complications. However, they are often overlooked in perioperative protocols and quality improvement measures. Optimizing recovery and patient satisfaction requires adopting evidence-based, patient-centered approaches to how postoperative information is delivered.
A foundational obstacle to consider when establishing effective postoperative instructions is poor health literacy. Over one-third of surgical patients have low health literacy, which is independently associated with worse outcomes, including higher complication rates and longer hospital stays.1,2 Despite this, many discharge instructions are written at an inappropriately high reading level.3 While organizations such as the American Medical Association and National Institutes of Health recommend materials in the patient’s preferred language, are essential. Confirming patient understanding and avoiding unnecessary medical jargon are critical steps in ensuring patients can actively participate in their recovery.1,3,4
Even when instructions are clear, the timing of their delivery remains a major barrier to successful adherence. Patients frequently have poor recall of information provided on the day of surgery. The effects of anesthesia and perioperative stress significantly impair memory and comprehension. Studies show that a majority of patients report poor recall of postoperative discussions, many are unable to remember even basic information shortly after discharge.5 This makes reliance on verbal instructions alone insufficient and highlights the need for materials explaining postoperative instructions that patients can revisit independently, whether in printed or digital form.
To address these limitations, multimodal instruction delivery has become increasingly important. The addition of audiovisual material improves patient comprehension, retention, and adherence to postoperative care plans.6,7 Patients receiving video-based instructions alone and often prefer a combination of both formats.7 These findings support integrating video as a standard adjunct rather than a supplemental tool.
Digital delivery platforms further enhance accessibility and usability. Patient-specific discharge instructions delivered electronically, such as via email or patient portals, improve understanding and satisfaction. Effective digital packages may include written instructions, visual aids, and personalized surgeon communication. Because these materials are easily accessible on mobile devices and can be shared with caregivers, they reinforce adherence and reduce reliance on follow-up clarification.5,8
Finally, the content of postoperative instructions must be standardized. Significant variability exists across institutions, and many discharge materials omit critical warning signs or key elements of postoperative care.3 Implementing standardized templates based on expert consensus ensures completeness and consistency. Structured approaches, such as Delphi methodology, can help define essential components, including symptom monitoring, medication guidance, and clear escalation instructions for complications.
By shifting away from generic paper handouts toward standardized, personalized, and health-literate digital formats, surgeons can dramatically improve patient comprehension of postoperative instructions. Implementing these best practices for postoperative instructions ensures that patients are fully empowered to manage their recovery, ultimately leading to better clinical outcomes and superior surgical experiences.
References
1. English NC, Jones BA, Chu DI. Addressing low health literacy in surgical populations. Clin Colon Rectal Surg. 2025;38(1):26-33. doi:10.1055/s-0044-1786389
2. Theiss LM, Wood T, McLeod MC, et al. The association of health literacy and postoperative complications after colorectal surgery: a cohort study. Am J Surg. 2022;223(6):1047-1052. doi:10.1016/j.amjsurg.2021.10.024
3. Scott AR, Sanderson CJ, Rush AJ III, et al. Constructing post-surgical discharge instructions through a Delphi consensus methodology. Patient Educ Couns. 2018;101(5):917-925. doi:10.1016/j.pec.2017.12.004
4. Cullen D, Samuels-Kalow ME. Measured Twice: Time for the Expansion of Social Care Interventions and Patient-Centered Outcomes. Ann Emerg Med. 2024;83(4):314-317. doi:10.1016/j.annemergmed.2023.12.001
5. Shultz K, Mastrocola M, Smith T, Busconi B. Patients have poor postoperative recall of information provided the day of surgery but report satisfaction with and high use of an e-mailed postoperative digital media package. Arthrosc Sports Med Rehabil. 2023;5(4):100757. doi:10.1016/j.asmr.2023.100757
6. Amato CA, White NW, Tio JD, Rodriguez W, Matullo KS. Postoperative instruction retention, written versus audiovisual adjuncts: a prospective randomized study. J Hand Surg Glob Online. 2024;6:146-150. doi:10.1016/j.jhsg.2023.10.009
7. Maffei JB, Song JJ, Saffati G, Khera M. Video discharge instructions increase patient understanding for office-based procedures: a randomized controlled study. Transl Androl Urol. 2025;14(3):678-684. doi:10.21037/tau-24-501
8. Santoro AJ, Ford EA, Pontes M, Busconi BD, McMillan S. Patient-specific e-mailed discharge instructions improve patient satisfaction and patient understanding after surgical arthroscopy. Arthrosc Sports Med Rehabil. 2022;4(4):e1315-e1322. doi:10.1016/j.asmr.2022.04.013