Limited health literacy does not adversely affect compliance with postoperative restrictions, 90-day emergency department return, or opioid use following shoulder arthroscopy

Abstract

Background

Limited health literacy can negatively impact how patients process medical information, make medical decisions, and navigate the healthcare system. The literature with regards to health literacy and its impact on both postoperative compliance and healthcare utilization remains scant.

Methods

We retrospectively analyzed the records for patients who underwent elective shoulder arthroscopy with a minimum 90-day follow-up at a single academic institution. Demographic data including age, gender, prior ipsilateral shoulder arthroscopy, body mass index and age-adjusted Charlson Comorbidity Index were collected. A validated 9-item literacy in musculoskeletal problems questionnaire to assess musculoskeletal health literacy was administered preoperatively. Postoperative compliance with therapy and surgeon-directed immobilization restrictions, 90-day return to emergency department (ED), and the number of opioid prescriptions filled within 3 months postoperatively was recorded.

Results

There were 252 cases included in this study. Seventy-seven (31%) patients demonstrated adequate musculoskeletal health literacy (MHL). On multivariable analysis, limited MHL (LMHL) was not significantly associated with 90-day postoperative ED return, compliance with postoperative surgeon instructions regarding shoulder motion or therapy restrictions, or obtaining ≥2 postoperative opioid prescriptions.

Conclusions

LMHL is highly prevalent among patients undergoing elective shoulder arthroscopy. The lack of association between LMHL and postoperative compliance, 90-day ED return, or filling ≥2 postoperative opioid prescriptions suggests that further research is needed to identify more relevant modifiable risk factors that could reduce these negative clinical outcomes and healthcare utilization patterns.