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Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery.
JAMA Surg 2018; 153(2):137-142JS

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.

Authors+Show Affiliations

Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee.Department Anesthesiology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28979989

Citation

Wright, Jesse P., et al. "Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery." JAMA Surgery, vol. 153, no. 2, 2018, pp. 137-142.
Wright JP, Edwards GC, Goggins K, et al. Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surg. 2018;153(2):137-142.
Wright, J. P., Edwards, G. C., Goggins, K., Tiwari, V., Maiga, A., Moses, K., ... Idrees, K. (2018). Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surgery, 153(2), pp. 137-142. doi:10.1001/jamasurg.2017.3832.
Wright JP, et al. Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. JAMA Surg. 2018 02 1;153(2):137-142. PubMed PMID: 28979989.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery. AU - Wright,Jesse P, AU - Edwards,Gretchen C, AU - Goggins,Kathryn, AU - Tiwari,Vikram, AU - Maiga,Amelia, AU - Moses,Kelvin, AU - Kripalani,Sunil, AU - Idrees,Kamran, PY - 2017/10/6/pubmed PY - 2019/9/17/medline PY - 2017/10/6/entrez SP - 137 EP - 142 JF - JAMA surgery JO - JAMA Surg VL - 153 IS - 2 N2 - 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. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/28979989/Association_of_Health_Literacy_With_Postoperative_Outcomes_in_Patients_Undergoing_Major_Abdominal_Surgery_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2017.3832 DB - PRIME DP - Unbound Medicine ER -