Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Picturing better outcomes: Illustrated educational booklets improve patient-reported outcomes and reduce healthcare utilization in abdominal transplantation
Marissa Di Napoli, Haaris Kadri, Danielle Kessler, Gabriella Canty, Katherine Klingenberg, Elizabeth A Pomfret, James J Pomposelli, Thomas Pshak, Rashikh A Choudhury, Trevor L Nydam, Maria Baimas-George
Marissa Di Napoli, Danielle Kessler, Katherine Klingenberg, Elizabeth A Pomfret, James J Pomposelli, Thomas Pshak, Rashikh A Choudhury, Trevor L Nydam, Maria Baimas-George, Department of Surgery, University of Colorado School of Medicine, Aurora, CO 80045, United States
Marissa Di Napoli, Department of Surgery, Willis Knighton Health, Shreveport, LA 71103, United States
Haaris Kadri, Gabriella Canty, School of Medicine, University of Colorado, Aurora, CO 80045, United States
James J Pomposelli, Department of Surgery, Tufts Medical Center, Boston, MA 02111, United States
Maria Baimas-George, Division of Abdominal Transplantation, Department of Surgery, Atrium Health, Wake Forest University School of Medicine, Charlotte, NC 28203, United States
Author contributions: Pomfret EA, Pomposelli JJ, Pshak T, Nydam TL, and Baimas-George M were involved in study design, provided supervision over the manuscript drafting; Di Napoli M, Kadri H, Kessler D, Canty G, Klingenberg K, and Baimas-George M analyzed data, drafted the original manuscript; all authors were involved in interpretation of findings; all authors approved the final version of the manuscript.
Supported by Donor Alliance Foundation Grant, No. 2023-2024-6024171170.
Institutional review board statement: This investigation was deemed exempt from review by the Colorado Multiple Institutional Review Board (No. 22-1134).
Informed consent statement: The need for patient consent was waived due to the nature of the study.
Conflict-of-interest statement: Dr. Baimas-George founded TerryBooks LLC. None of the other authors have relevant conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data may be made available upon reasonable request from the corresponding author.
Corresponding author: Maria Baimas-George, MD, MPH, Assistant Professor, Division of Abdominal Transplantation, Department of Surgery, Atrium Health, Wake Forest University School of Medicine, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, United States.
maria.baimasgeorge@advocatehealth.org
Received: January 23, 2026
Revised: February 14, 2026
Accepted: March 26, 2026
Published online: June 18, 2026
Processing time: 126 Days and 8 Hours
BACKGROUND
Patient education remains an underdeveloped component of care in abdominal transplantation. Despite the benefits of improved health literacy, most educational materials remain inaccessible to the average patient.
AIM
To evaluate the impact of educational booklets on comprehension, anxiety, satisfaction, and healthcare utilization among abdominal transplant recipients and donors.
METHODS
An observational, single-center quality improvement study was conducted in transplant recipients and living donors. Patients received booklets during transplant evaluation, preoperative clinic, or hospital admission. Booklets were developed by transplant surgeons and revised with health literacy experts. Postoperative surveys assessed comprehension, satisfaction, anxiety, and feedback. Patient-reported demographic data and post-operative outcomes were collected from the electronic medical record were analyzed.
RESULTS
Eighty-three patients completed the survey, of which nine were excluded for duplicate entries. Satisfaction with content was high, with 81% reporting reduced feelings of overwhelm and 74% reporting less fear of surgery. The average recommendation rating was 9.4/10, with frequent praise for illustrations, glossary, and surgical explanations. Postoperative outcomes improved following booklet implementation, with reductions in readmission rates, emergency department visits, and coordinator calls. Compared with historical data, readmissions decreased significantly (12.2% vs 22.1%; P = 0.049).
CONCLUSION
Illustrated educational booklets significantly improved patient comprehension, anxiety, and satisfaction, and reduced unplanned care use. Integrating tailored education into routine transplant care enhances patient experiences and outcomes.
Core Tip: Patient education is paramount in ensuring appropriate postoperative outcomes and expectations of the perioperative process. This study highlights that current educational tools for patients undergoing abdominal transplantation may be inadequate, and that illustrated booklets serve patients well. Overall, there was a decrease in postoperative healthcare utilization in the form of readmissions, as well as reduced feelings of overwhelm and fear in the preoperative setting.
