The association of health literacy and postoperative complications after colorectal surgery: A cohort study.

BACKGROUND: Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes. METHODS: Retrospective cohort study of patients undergoing elective colorectal surgery 2015-2020. Health literacy assessed using Brief Health Literacy Screening Tool. Outcomes were postoperative complications, LOS, readmissions, mortality. RESULTS: Of 552 patients, 46 (8.3%) had limited health literacy, 506 (91.7%) non-limited. Median age 57.7 years, 305 (55.1%) patients were female, 148 (26.8%) were Black. Limited patients had higher rates of overall complications (43.5% vs. 24.3%, p = 0.004), especially surgical site infections (21.7% vs. 11.3%, p = 0.04). Limited patients had longer LOS (5 vs 3.5 days, p = 0.006). Readmissions and mortality did not differ. On multivariable analysis, limited health literacy was independently associated with increased risk of complications (OR 2.03, p = 0.046), not LOS (IRR 1.05, p = 0.67). CONCLUSION: Limited health literacy is associated with increased likelihood of complications after colorectal surgery. Opportunities exist for health literate surgical care to improve outcomes for limited health literacy patients.

Multidisciplinary clinics for colorectal cancer may not provide more efficient coordination of care.

BACKGROUND: This retrospective study compares a multidisciplinary clinic (MDC) to standard care for time to treatment of colorectal cancer. METHODS: We queried our institutional ACS-NSQIP database for patients undergoing surgery for colorectal cancer from 2017 to 2020. Patients were stratified by initial clinic visit (MDC vs control). Primary endpoint was the time to start treatment (TST), either neoadjuvant therapy or surgery, from the date of diagnosis by colonoscopy. RESULTS: A total of 405 patients were evaluated (115 MDC, 290 Control). TST from diagnosis was not significantly shorter for the MDC cohort (MDC 30 days, Control 37 days; p = 0.07) even when stratified by type of initial treatment of neoadjuvant therapy (MDC 30, Control 34 days; p = 0.28) or surgery (MDC 32.5 days, Control 38 days; p = 0.35). CONCLUSION: Implementation of an MDC provides insignificant reduction in delay to start treatment for colorectal cancer patients as compared to standard care colorectal surgery clinics. CLASSIFICATION: Colorectal.

The Trainee's Role in Patient Safety: Training Residents and Medical Students in Surgical Patient Safety.

"The focus on patient safety offers a new framework not only for delivering health care but also for training physicians. Medical school and surgical graduate medical education must transition to a more holistic approach by teaching technical and nontechnical skills. Formalized safety curricula can be developed by adopting recommended guidelines and content from national and international organizations, existing validated practices of training programs, frequent simulation exercises, and objective evaluation tools."

The effect of obesity on fatty infiltration of the rotator cuff musculature in patients without rotator cuff tears.

BACKGROUND: The modified Goutallier classification system describes the fatty infiltration of rotator cuff musculature (RCM) seen on magnetic resonance imaging (MRI) to assist with surgical decision-making for patients with rotator cuff tears (RCT). We describe the relationship between body mass index (BMI) and fatty infiltration in patients without RCT. METHODS: Twenty-five patients from each of four different BMI ranges (< 25 kg/m2; 25 kg/m2 to 30 kg/m2; 30 kg/m2 to 35 kg/m2; > 35 kg/m2) were randomly selected from 1088 consecutive shoulder MRI scans (T1 parasagittal series). Four physician-readers evaluated MRI scans and assigned modified Goutallier grades (0 to 4) in each of the four rotator cuff muscles, as well as two adjacent muscles. RESULTS: Grade distributions varied significantly based on BMI category for infraspinatus (p = 0.001), teres minor (p < 0.001), subscapularis (p = 0.025), teres major (p < 0.001) and deltoid (p < 0.001). Higher grades were evident with a diagnosis of diabetes mellitus in three of six muscles (p < 0.05), hyperlipidaemia in one muscle (p = 0.021) and greater patient age in three muscles (p < 0.05). CONCLUSIONS: Obese and severely obese patients without RCT have more fatty infiltration seen on MRI. Patient factors (older age and diagnosis of diabetes mellitus) can be predictive of fatty infiltration in RCM. Fatty infiltration of RCM is not solely attributable to the presence of a RCT.