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Original Investigation
October 4, 2017

Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery

Author Affiliations
  • 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • 2Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Department Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
  • 4Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • 5Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Surg. Published online October 4, 2017. doi:10.1001/jamasurg.2017.3832
Key Points

Question  What is the association of health literacy with postoperative outcomes in patients undergoing major inpatient abdominal surgery?

Findings  In a this study of 1239 patients who were undergoing major abdominal surgery, lower health literacy levels were independently associated with an increased index hospitalization length of stay. However, low health literacy was not associated with increased emergency department visits or hospital readmissions following discharge.

Meaning  Identifying patients with low health literacy and addressing their specific needs may facilitate timely hospital discharges and decreased lengths of stay.

Abstract

Importance  Low health literacy is known to adversely affect health outcomes in patients with chronic medical conditions. To our knowledge, the association of health literacy with postoperative outcomes has not been studied in-depth in a surgical patient population.

Objective  To evaluate the association of health literacy with postoperative outcomes in patients undergoing major abdominal surgery.

Design, Setting, and Participants  From November 2010 to December 2013, 1239 patients who were undergoing elective gastric, colorectal, hepatic, and pancreatic resections for both benign and malignant disease at a single academic institution were retrospectively reviewed. Patient demographics, education, insurance status, procedure type, American Society of Anesthesiologists status, Charlson comorbidity index, and postoperative outcomes, including length of stay, emergency department visits, and hospital readmissions, were reviewed from electronic medical records. Health literacy levels were assessed using the Brief Health Literacy Screen, a validated tool that was administered by nursing staff members on hospital admission. Multivariate analysis was used to determine the association of health literacy levels on postoperative outcomes, controlling for patient demographics and clinical characteristics.

Main Outcomes and Measures  The association of health literacy with postoperative 30-day emergency department visits, 90-day hospital readmissions, and index hospitalization length of stay.

Results  Of the 1239 patients who participated in this study, 624 (50.4%) were women, 1083 (87.4%) where white, 96 (7.7%) were black, and 60 (4.8%) were of other race/ethnicity. The mean (SD) Brief Health Literacy Screen score was 12.9 (SD, 2.75; range, 3-15) and the median educational attainment was 13.0 years. Patients with lower health literacy levels had a longer length of stay in unadjusted (95% CI, 0.95-0.99; P = .004) and adjusted (95% CI, 0.03-0.26; P = .02) analyses. However, lower health literacy was not significantly associated with increased rates of 30-day emergency department visits or 90-day hospital readmissions.

Conclusions and Relevance  Lower health literacy levels are independently associated with longer index hospitalization lengths of stay for patients who are undergoing major abdominal surgery. The role of health literacy needs to be further evaluated within surgical practices to improve health care outcomes and use.

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