B. A. Jones1, A. H. Harsono2,4, L. Wood2, B. P. Smith2, M. Rubyan3, R. H. Hollis2, D. I. Chu2 3University Of Michigan, School Of Public Health, Ann Arbor, MI, USA 4University Of Alabama at Birmingham, School Of Public Health, Birmingham, Alabama, USA 1University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA 2University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction:
Enhanced recovery programs (ERPs) are standardized multicomponent perioperative care pathways that have transformed surgical care. Yet, their efficacy is dependent on fidelity (adherence to the many components of ERPs). Preoperative education is a critical component of ERP that reduces patient anxiety and improves patients’ preparedness, satisfaction, and overall surgical experiences. However, variations exist in preoperative education fidelity. Therefore, the goal of this study was to determine the factors that are associated with fidelity to preoperative education.
Methods:
We performed a retrospective cohort study of all patients (n=349) undergoing elective colorectal surgery at our institution from January 2022 to April 2022. Data was acquired from our institution’s enhanced recovery database and then linked to our institution’s ACS-NSQIP database and BRIEF data measuring patient health literacy (HL). Primary analysis aimed to identify factors associated with preoperative education. Secondary analysis examined the associations of preoperative education with surgical outcomes. Kruskal-Wallis and Pearson’s chi-squared tests were used to assess unadjusted differences and logistic regression for adjusted differences.
Results:
Of 349 patients, the median age was 56.5 years with 57.9% female patients. The number of patients adherent to preoperative education was 221 (63.3%). Overall, 242 (69.3%) patients had adequate HL, 69 (19.8%) marginal HL and 38 (10.9%) inadequate HL. There were no differences in adherence to preoperative education with respect to patient age, race, gender or BMI. The two groups that showed differences were procedure type (p=0.017) and HL (<0.001). Patients with marginal and inadequate HL had higher rates of non-adherence (52.3% and 39.5%, respectively) versus those with adequate HL (29.8%). After adjusting for procedure type and HL, logistic regression identified HL as the only predictor of non-adherence. Specifically, patients with marginal HL had lower odds (OR=0.273) of receiving preoperative education compared to patients with adequate HL (p<0.001). Inadequate versus adequate HL also had lower odds (OR=0.604), though not significant (p=0.1681). Preoperative education was associated with shorter length-of-stay (LOS) (p=0.037) and no postoperative transfusion requirement (p=0.041). LOS for patients adherent was 3 days versus 4 days for patients who were non-adherent. Patients requiring postoperative transfusions had a higher rate of non-adherence (56.5% versus 35.3%).
Conclusion:
Preoperative education is a key component to ERPs and is associated with outcomes including shorter LOS. However, patients with marginal and inadequate HL are at significant risk for not receiving preoperative education. An opportunity therefore exists to improve delivery and potentially the quality of preoperative education for this patient population to impact outcomes and reduce disparities.