G. C. Edwards1, K. M. Goggins2, J. Ehrenfeld3, H. R. Mir4, A. A. Parikh1, N. B. Merchant1, S. B. Kripalani2, K. Idrees1 2Vanderbilt University Medical Center,Center For Health Services Research,Nashville, TN, USA 3Vanderbilt University Medical Center,Department Of Anesthesiology, Vanderbilt Anesthesiology & Perioperative Informatics Research (VAPIR) Division,Nashville, TN, USA 4Vanderbilt University Medical Center,Department Of Orthopaedics & Rehabilitation,Nashville, TN, USA 1Vanderbilt University Medical Center,Department Of Surgery, Division Of Surgical Oncology,Nashville, TN, USA
Introduction:
Health literacy (HL) is broadly defined as an individual’s ability to obtain, process, and understand health information in order to make informed health care decisions. Low HL status adversely affects health outcomes in patients living with chronic diseases such as diabetes, hypertension, and congestive heart failure. However, the link between HL and post-operative outcomes has not been evaluated in the surgical population. The aim of this study is to evaluate the influence of HL on post-operative outcomes in patients undergoing major abdominal surgery.
Methods:
From 2010 to 2013, 1,376 patients undergoing elective gastric, colorectal and hepato-pancreatico-biliary resections at a single academic institution were assessed. Patient demographics, education and insurance status, procedure type, American Society of Anesthesiologists (ASA) status, Charlson comorbidity index (CCI), and post-operative outcomes [complications, length of stay (LOS), 30- and 90-day emergency department (ED) visits, and 30- and 90-day unplanned hospital readmissions] were obtained from the electronic medical records. HL was assessed using the Brief Health Literacy Screen (BHLS), a validated tool administered by nursing staff upon hospital admission. This tool is scored 3-15 and divided into four HL categories [low (3-8), intermediate (9-11), intermediate-high (12-14), and high (15)]. Multivariable logistic regression modeling was utilized to determine the association of HL and other covariates on post-operative outcomes.
Results:
In this cohort, there was a median HL score of 15.0 and a median educational attainment of 13.0 years. Hospital readmission and re-presentation to the ED within 30 days were 16% and 13.5%, respectively, and within 90 days were 19% and 16%, respectively. ASA status, pancreatic and gastric resections, and postoperative complications were independently associated with increased LOS [p<0.05], while post-operative complications [OR 3.482, CI 2.4-5.1, p<0.001], increased LOS [OR 0.972, CI 0.953-0.992, p=0.007], and higher CCI [OR 0.949, CI 0.905-0.992, p=0.030] were associated with increased rates of readmission within 90 days. After controlling for all factors, patients with a higher HL score had a shorter LOS [p=0.016]. However, low HL was not significantly associated with increased rates of complications [OR 0.994, CI 0.935-1.056], 30- or 90-day hospital readmission [OR 0.972, CI 0.921-1.026], or 90-day ED visits [OR 0.991, CI 0.935-1.050].
Conclusion:
Higher HL status is independently associated with shorter LOS in patients undergoing major abdominal surgery. In contrast, lower HL status is not associated with increased complication rates or 30- and 90-day hospital readmissions or ED visits. Decreased LOS results in decreased hospital cost and improved overall patient satisfaction. Therefore, the role of health literacy should be considered within surgical practice to improve health care utilization.