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

Abstract

Background: Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Colorectal surgery; Health literacy; Surgical disparities; Surgical outcomes.

Figure 1.

Breakdown and timing of all complication occurrences for patients with limited and non-limited health literacy. Bubble size reflects relative number of occurrences of each complication type. DVT indicates deep venous thrombosis; PTE, pulmonary thromboembolism; C diff, clostridium difficile infection; CVA, cerebrovascular accident; UTI, urinary tract infection. ¹ Complication presentation prior to discharge from index surgical encounter ² Complication presentation after discharge from index surgical encounter