The mediating role of pre-operative patient readiness on surgical outcomes: A structural equation model analysis.

Journal Article (Journal Article)


To determine the mediating role of surgical readiness on patient characteristics (surgical risk, type of surgery, pre-operative anxiety, and health literacy) and its influence on surgical outcomes (pain, postoperative complications, and surgical experience).


Correlational, theory testing using structural equation modelling.


A total of 376 consecutively selected surgical patients from four tertiary hospitals were recruited and followed-up 48-72 hr postoperatively from May-October 2017. Consenting respondents answered questionnaires measuring basic surgical information, health literacy, anxiety, surgical readiness, pain score, and surgical experience. Further, records review was conducted to identify occurrence of any postoperative complications and use of additional analgesics.


A good fit and parsimonious model (χ2 /df = 0.75, RMSEA = 0.00, GFI = 0.99, CFI = 1.00, PNFI = 0.50) highlighted the mediating effect of pre-operative readiness between patient characteristics and surgical outcomes. The type of surgery (curative) influenced patient readiness, surgical complications, and use of additional postoperative analgesics. Higher health literacy negatively influenced patient readiness; can decrease the use of postoperative analgesics; and lessen postoperative pain. Further, pre-operative anxiety decreased patient readiness and increased postoperative pain and negatively influenced the surgical experience.


Patient readiness is beyond the physiological aspect of pre-operative preparation and it is influenced primarily by the mental and emotional state of a patient. Addressing issues such as anxiety and health literacy can improve pre-operative readiness that can enhance pain management and surgical experience. Hence, the mediating role of readiness in improving surgical outcomes emphasizes the need to deliver a patient-centred and individualized approach to patient preparation with a key focus on their readiness for surgery.


This study demonstrates the difference between preparing patients and promoting readiness for surgery. Surgical readiness requires patient-centred approach in promoting a more engaged and confident patient who is capable to use appropriate health information and how it can lead to better surgical outcomes.

Full Text

Duke Authors

Cited Authors

  • Torres, GCS; Relf, MV; Tuazon, JA

Published Date

  • June 2020

Published In

Volume / Issue

  • 76 / 6

Start / End Page

  • 1371 - 1383

PubMed ID

  • 32128862

Electronic International Standard Serial Number (EISSN)

  • 1365-2648

International Standard Serial Number (ISSN)

  • 0309-2402

Digital Object Identifier (DOI)

  • 10.1111/jan.14339


  • eng