Health Literacy Tied to Outcomes in Patients Undergoing Day Surgery

More patients are undergoing surgical procedures performed as day surgery with much of their recovery time at home without the direct supervision of a healthcare professional; therefore, these patients must possess functional health literacy (FHL) to understand instructions on how to manage their recovery at home. A new study¹, published in JAMA Surgery, described FHL among patients in Sweden who were undergoing day surgery and the association of FHL with postoperative recovery.

The observational study, part of a multicenter, 2-group, parallel, single-blind randomized clinical trial conducted from 2015 to 2016 at 4 day-surgery facilities in Sweden, included 704 patients, all of whom had completed an FHL questionnaire that measured visual ability related to text design and accessibility; understanding words and concepts; the ability to persevere in reading; and the need for help in reading and understanding information. Most patients (60.6%) reported that they had sufficient FHL, 31.7% reported problematic FHL, and 54% reported that they had inadequate FHL.

In patients with problematic and inadequate FHL, quality of recovery was poorer; the group with inadequate FHL had a global quality of recovery score (measured on a scale on which 0 is excellent recovery and 240 is poor recovery) of 37.2, and the group with problematic FHL had a score of 22.9, while the group with sufficient FHL had a score of 17.7.

The most differences in recovery were found between the groups who had inadequate and sufficient FHL. Those with inadequate FHL had the following when compared with those with sufficient FHL:

• More trouble breathing
• More trouble sleeping
• Lower general feeling of well-being
• Less sense of control over situations
• More difficulty relaxing
• More changes to voice
• Greater difficulty taking care of personal hygiene
• More dizziness
• More depression
• More anxiety
• More mouth soreness
• More difficulty concentrating
• More incidence of fever

Health-related quality of life, as measured by the EuroQol-visual analog scale, also revealed poorer outcomes for those with inadequate FHL; this group had worse scores for physical function, vitality, social functioning, and mental health.

“Our results suggest that functional health literacy can now also be included as an influencing factor for the quality of postoperative recovery,” wrote the authors, who added that FHL should be considered a relevant factor in considering how to best optimize recovery for patients undergoing day surgery.

In a linked commentary,² Jesse P Wright, MD; Kelvin Moses, MD, PhD; and Kamran Idrees, MD, MSCI, MMHC, wrote that “we question if patients are able to equally discern the difference in the questioning in the quality of recovery and [quality of life] questionnaires” used in the study, but said that “The findings in this ambulatory setting mirror findings by our group where we reported an association of low health literacy with various postoperative metrics, including increased hospital length of stay and use of discharge resources in patients undergoing surgical procedures.”

The commentary’s authors say that investment in development of validated tools to measure FHL will generate the empirical data necessary to develop and use appropriate health literacy interventions.

References

1. Nyman MH, Nilsson U, Dahlberg K, Jaensson M. Association between functional health literacy and postoperative recovery, health care contacts, and health-related quality of life among patients undergoing day surgery, secondary analysis of a randomized clinical trial [Published online April 25, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.0672.

2. Wright JP, Moses K, Idrees K. Making the case for importance of health literacy in the surgical population. [Published online April 25, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.0673.