The association of health literacy and postoperative complications after colorectal surgery: A cohort study

• Published in: The American journal of surgery Vol. 223; no. 6; pp. 1047 - 1052
• Main Authors: Theiss, Lauren M., Wood, Tara, McLeod, Marshall C., Shao, Connie, Santos Marques, Isabel Dos, Bajpai, Swara, Lopez, Elizabeth, Duong, Anh M., Hollis, Robert, Morris, Melanie S., Chu, Daniel I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022; Elsevier Limited
• Subjects: Cohort analysis; Cohort Studies; Colorectal Surgery; Complications; Demographics; Elective Surgical Procedures - adverse effects; Electronic health records; Female; Health education; Health Literacy; Humans; Infections; Length of Stay; Literacy; Male; Medical records; Middle Aged; Mortality; Patients; Postoperative; Postoperative Complications - etiology; Postoperative period; Retrospective Studies; Surgery; Surgical disparities; Surgical outcomes; Surgical site infections; Thrombosis; Surgical outcomes; Health literacy; Colorectal surgery; Surgical disparities
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.10.024

Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes. Retrospective cohort study of patients undergoing elective colorectal surgery 2015–2020. Health literacy assessed using Brief Health Literacy Screening Tool. Outcomes were postoperative complications, LOS, readmissions, mortality. Of 552 patients, 46 (8.3%) had limited health literacy, 506 (91.7%) non-limited. Median age 57.7 years, 305 (55.1%) patients were female, 148 (26.8%) were Black. Limited patients had higher rates of overall complications (43.5% vs. 24.3%, p = 0.004), especially surgical site infections (21.7% vs. 11.3%, p = 0.04). Limited patients had longer LOS (5 vs 3.5 days, p = 0.006). Readmissions and mortality did not differ. On multivariable analysis, limited health literacy was independently associated with increased risk of complications (OR 2.03, p = 0.046), not LOS (IRR 1.05, p = 0.67). Limited health literacy is associated with increased likelihood of complications after colorectal surgery. Opportunities exist for health literate surgical care to improve outcomes for limited health literacy patients. •Limited health literacy patients have 2x higher odds of postoperative complications.•Limited health literacy patients are at the highest risk for surgical site infections.•Opportunities exist for more health literate care to optimize surgical outcomes.