51.20 Effects of Education and Health Literacy on Post-Operative Outcomes in Bariatric Surgery

S. Mahoney², D. Tawfik-Sexton¹, P. Strassle³, T. Farrell¹, M. Duke^{1  1}University Of North Carolina At Chapel Hill,Division Of Gastrointestinal Surgery,Chapel Hill, NC, USA ²University Of North Carolina At Chapel Hill,Dept. Of Surgery,Chapel Hill, NC, USA ³University Of North Carolina At Chapel Hill,Gillings School Of Global Public Health, Department Of Epidemiology,Chapel Hill, NC, USA

Introduction:
In bariatric surgery, strict adherence to diet and lifestyle modifications are necessary for a successful operative course. We hypothesize that lower levels of education and health literacy are associated with increased risks of nonadherence; thus leading to increased morbidity, emergency department (ED) visits, and preventable readmissions postoperatively. If so, pre-operative education and follow up care may be individualized to benefit those at-risk patients.

Methods:
Bariatric surgery patients were administered a pre-operative questionnaire which included education level and the Rapid Estimate of Adult Literacy in Medicine (REALM-SF) assessment. Patients were stratified by education level (≤12 years of education versus >12 years) and health literacy score (a score ≤6 [7^th-8^th grade or lower] versus 7 [high school]). Poisson regression was used to compare incidence rate of ED visits, readmission, and overall hospital visits. 

Results:
Of the 73 enrolled patients, 16 (22.2%) had ≤12^th grade education and 5 (6.9%) scored ≤6 on the REALM-SF. Patients with lower education were significantly more likely to visit the hospital following surgery, 0.40/100 days (95% CI 0.19, 0.84) vs. 0.15/100 days (95% CI 0.08, 0.28), p=0.05. ED visits (0.18/100 days vs. 0.07/100 days, p=0.15) and readmissions (0.18/100 days vs. 0.07/100 days, p=0.16) were higher, but not significant, among patients with lower education.  No significant differences were seen in patients with lower health literacy in the rate of ED visits (0.09/100 days vs. 0.09/100 days, p=0.97), readmissions (0.11/100 days vs. 0.09/100 days, p=0.87), or overall hospital visits (0.22/100 days vs. 0.19/100 days, p=0.85).
 

Conclusion:
Lower level of education is associated with more than double the rate of post-operative hospital visits in our center’s bariatric surgery patients. Very few of our patients made less than a perfect score on the REALM-SF, limiting its effectiveness as a screening tool for risk stratification. A patient’s education level is quick and free to obtain and may identify patients at risk for costly post-operative hospital visits.  Further investigation is warranted in order to improve outcomes and unnecessary costs associated with bariatric surgery.