W. Rafaqat2, B. P. Smith3, L. Wood3, X. Rongbing3, B. Jones3, R. Hollis3, R. Hollis3, A. H. Harsono3, S. Chowhuri3, D. I. Chu3 2Aga Khan University Medical College, Karachi, Sindh, Pakistan 3University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Low health literacy (HL) has been associated with higher treatment costs in chronic diseases, but little is known about its impact on costs among surgical patients. Therefore, this study aimed to assess the impact of HL on costs among patients undergoing elective colorectal procedures.
Methods: : A retrospective cohort study of patients undergoing elective colorectal procedures between 2018 and 2021 at a single tertiary care academic medical center was conducted. Using the 3-item BRIEF health literacy score, patients were classified into adequate (scores 12-15), marginal (scores 9-11), and limited (scores 3-8) HL groups. Primary outcomes (fixed, variable, and total costs of surgical encounter and 30-days post-discharge) were compared between the groups.
Results: : A total of 375 patients were included with 312 (83%), 33 (8%) and 30 (9%) patients belonging to the adequate, marginal, and limited HL groups respectively. Average patient age was 57.3 (48.1-68.2) years, average BMI was 28.7 (24.3-33.4) kg/m2, 42% patients were male, and 25% of patients were Black. Patients with limited health literacy were the oldest (p=0.007) and had the longest lengths-of-stay (p=0.016). The most common procedure was partial or extended colectomy (61%), followed by abdominoperineal resection or exenteration (38%) and ostomy reversal (8%). Cost analysis showed that overall costs were highest among those with marginal HL ($20,086 ± $10,832) compared to adequate ($19,168 ± $12,334) and limited ($17,946 ± $6,203) HL groups although this difference was not statistically significant (p=0.59). The marginal HL group had the highest fixed ($10,557 ± $3,850; p= 0.68), variable ($7,677 ± $3,044; p= 0.94) and total surgical encounter ($18,235± $6,722; p= 0.81) costs compared to those with adequate (fixed costs $10,383 ± $6,562, variable costs $7754 ± $5082, and total costs $18,137 ± $11,199) and limited HL (fixed costs $9,433 ± $3,070, variable costs $7450 ± $2935 total costs $16,883 ± $5,706). Adjusted overall 30-day post-discharge total ($1,031± $3,743; p= 0.59), variable ($510± $2,015; p= 0.78), and fixed ($520 ± $1,880; p=0.42) costs were all lower in the adequate HL group compared to the marginal (total $1,850 ± $7,472, variable $801± $3,526, and fixed costs $1,049 ± $3,959) or limited HL group (total $1,061± $3,978, variable $527± $2,017, fixed costs $534 ± $1,961), although these differences were not statistically significant.
Conclusion: Patients with marginal HL had higher overall costs and surgical encounter costs. These findings highlight the financial burden of health literacy and identify an important population for cost reduction efforts.