BACKGROUND: 

Low health literacy (HL) adversely affects medical adherence and health outcomes in patients with chronic diseases. However, the association between HL and enhanced recovery after surgery (ERAS) adherence and postoperative outcomes has not been investigated in patients undergoing colorectal surgery.

METHODS: 

The data of all patients from a single academic institution who underwent colorectal surgery on an ERAS pathway from January 2019 to July 2020 were prospectively collected. HL levels were assessed using the Brief Health Literacy Screen (BHLS), a proven tool that was used by surgeons after recruitment. According to the HL score, the participants were categorized into low HL (≤9 points) and high HL (10–15 points) groups. The primary outcome was ERAS adherence. Adherence was measured in 22 perioperative elements, and high adherence was defined as adherence to 17 to 22 elements. Secondary outcomes included postoperative complications, hospital length of stay (LOS), hospital charges, mortality, and readmissions.

RESULTS: 

Of the 865 eligible patients, the high HL group consisted of 329 patients (38.0%), and the low HL group contained 536 patients (62.0%). After propensity score matching (1:1), 240 unique pairs of patients with similar characteristics were selected. Patients with high HL levels had a significantly higher rate of high adherence to ERAS standards than those with low HL levels (55% vs 25.8%; adjusted P < .001). In terms of adherence to each item, high HL levels were significantly associated with higher adherence to preoperative optimization (90.8% vs 71.7%; adjusted P < .001), postoperative gum chewing (59.2% vs 44.6%; adjusted P = .01), early feeding (59.2% vs 31.3%; adjusted P < .001), and early mobilization (56.7% vs 30.4%; adjusted P < .001). In the overall study population, adjusted logistic regression analyses also showed that high HL levels were associated with a significantly increased rate of high adherence when compared with low HL levels (adjusted odds ratio [OR], 3.57; 95% confidence interval (CI), 2.50–5.09; P < .001). In addition, low HL levels were associated with a significantly higher incidence of postoperative complications (32.1% vs 20.8%; P < .01), longer hospital LOS (9 [interquartile range {IQR}, 7–11] vs 7 [IQR, 6–9] d; P < .001), and higher hospital charges (10,489 [IQR, 8995–11942] vs 8466 [IQR, 7733–9384] dollar; P < .001) among propensity-matched patients. However, there were no differences in the mortality and readmission rates between the HL groups.

CONCLUSIONS: 

Low HL levels were associated with lower adherence to ERAS elements among propensity-matched patients undergoing colorectal surgery.

中文翻译：

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接受结直肠癌手术的患者的健康素养与术后康复方案依从性和术后结果之间的关联：一项前瞻性队列研究

背景： 

低健康素养 (HL) 会对慢性病患者的医疗依从性和健康结果产生不利影响。然而，尚未在接受结直肠手术的患者中研究 HL 与术后加速恢复 (ERAS) 依从性和术后结果之间的关系。

方法： 

前瞻性收集了 2019 年 1 月至 2020 年 7 月来自单一学术机构的所有通过 ERAS 途径接受结直肠手术的患者的数据。HL 水平使用简要健康素养筛查 (BHLS) 进行评估，这是一种经过验证的工具，外科医生在招募后使用。根据HL评分，参与者分为低HL（≤9分）和高HL（10-15分）组。主要结果是 ERAS 依从性。在 22 个围手术期元素中测量依从性，高依从性定义为对 17 到 22 个元素的依从性。次要结局包括术后并发症、住院时间 (LOS)、住院费用、死亡率和再入院率。

结果： 

在 865 名符合条件的患者中，高 HL 组包括 329 名患者（38.0%），低 HL 组包括 536 名患者（62.0%）。在倾向评分匹配 (1:1) 后，选择了 240 对具有相似特征的独特患者。HL 水平高的患者对 ERAS 标准的高依从率显着高于 HL 水平低的患者（55% 对 25.8%；调整后的P < .001）。就每个项目的依从性而言，高 HL 水平与更高的术前优化依从性（90.8% 对 71.7%；调整后的P < .001）、术后口香糖咀嚼（59.2% 对 44.6%；调整后的P = .01）显着相关、早期喂养（59.2% 对 31.3%；调整后的P < .001）和早期活动（56.7% 对 30.4%；调整后P < .001)。在整个研究人群中，调整后的逻辑回归分析还表明，与低 HL 水平相比，高 HL 水平与高依从率显着增加相关（调整优势比 [OR]，3.57；95% 置信区间（CI）， 2.50–5.09；P < .001)。此外，低 HL 水平与显着较高的术后并发症发生率（32.1% vs 20.8%；P < .01）、较长的住院时间（9 [四分位距 {IQR}，7-11] vs 7 [IQR， 6–9] d；P < .001)，以及更高的住院费用（10,489 [IQR, 8995–11942] vs 8466 [IQR, 7733–9384] 美元；P< .001) 在倾向匹配的患者中。然而，HL组之间的死亡率和再入院率没有差异。

结论： 

在接受结直肠手术的倾向匹配的患者中，低 HL 水平与较低的 ERAS 元素依从性相关。