Abstract
Introduction
Low health literacy (HL) is associated with poor surgical outcomes in patients with
abdominal tumors, despite enhanced recovery programs. However, the relationship between
HL and postoperative outcomes, including health-related quality of life (HRQOL) and
physical functions, has been unclear in patients with abdominal tumors receiving perioperative
rehabilitation programs (PRPs).
Our objective was to identify associations of HL with postoperative functional and
general outcomes in patients with abdominal tumors undergoing surgery and PRPs, controlling
for critical covariates.
Materials and Methods
The prospective cohort study was conducted from April 2020 to December 2021 in a single
acute care hospital in Akita City, Japan. Out of 112 consecutive older adults with
abdominal tumors referred to PRPs before surgery for tumors, 101 participated. Three
patients declined undergoing follow-up assessment, and thus 97 were analyzed. Demographic
data, comorbidities, education, surgical procedure, frailty status, cognitive functions,
physical activity, nutritional status, tumor sites, types, and stages were collected
as covariates at baseline. All participants underwent PRPs. HL was measured using
the Japanese version of the European Health Literacy Survey Questionnaire, a comprehensive
HL measurement. Primary endpoints were changes in HRQOL, measured using the EuroQol
5-dimension 5-level (EQ-5D-5L) index and EuroQol-visual analog scale (EQ-VAS), and
physical functions (chair-stand ability, usual gait speed, and grip strength) from
before surgery to discharge. Secondary endpoints were 90-day readmissions, postoperative
complications, and length of hospital stay. Multivariate regression with inverse probability
weighting, using propensity scores, estimeted associations of HL with the outcomes.
Results
Of the 97 patients (36 [37.1%] women, mean [standard deviation] age 74.4 [6.3] years),
42 (43.3%) reported low HL. At baseline, patients with low HL exhibited worse EQ-5D-5L
scores (P = .001), EQ-VAS values (P = .03), chair-stand ability (P = .001), and gait speed (P = .03) than controls. Low HL was associated with a low risk of grip strength declines
(risk ratio, 0.13; 95% confidence interval, 0.12–0.99) but not with any other outcome.
Discussion
There appeared to be no apparent associations of HL with surgical outcomes in patients
with abdominal tumors receiving PRPs. Thus, HL might not be a crucial predictor of
surgical outcomes when combined with PRPs.
Keywords
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Article info
Publication history
Published online: January 17, 2023
Accepted:
December 21,
2022
Received in revised form:
November 13,
2022
Received:
July 15,
2022
Identification
Copyright
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