Iwakura Masahiro, Kawagoshi Atsuyoshi, Furukawa Yutaka, Sugawara Keiyu, Wakabayashi Toshiki, Sato Tsutomu, Wakasa Masahiko
Department of Rehabilitation, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita 010-0933, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1 Hondo 1-chome, Akita City, Akita 010-8543, Japan.
Department of Rehabilitation, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita 010-0933, Japan.
J Geriatr Oncol. 2023 Mar;14(2):101422. doi: 10.1016/j.jgo.2022.101422. Epub 2023 Jan 17.
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.
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.
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.
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.
尽管有强化康复计划，但健康素养低下与腹部肿瘤患者的手术预后不良有关。然而，在接受围手术期康复计划（PRP）的腹部肿瘤患者中，健康素养与术后预后（包括健康相关生活质量（HRQOL）和身体功能）之间的关系尚不清楚。我们的目的是确定在接受手术和PRP的腹部肿瘤患者中，健康素养与术后功能和总体预后之间的关联，并控制关键协变量。
前瞻性队列研究于2020年4月至2021年12月在日本秋田市的一家急性护理医院进行。在112名连续的腹部肿瘤老年患者中，这些患者在手术前被转诊至PRP，其中101名患者参与。3名患者拒绝接受随访评估，因此对97名患者进行了分析。在基线时收集人口统计学数据、合并症、教育程度、手术程序、虚弱状态、认知功能、身体活动、营养状况、肿瘤部位、类型和分期作为协变量。所有参与者均接受PRP。使用欧洲健康素养调查问卷的日语版本测量健康素养，这是一种全面的健康素养测量方法。主要终点是使用欧洲五维五水平（EQ-5D-5L）指数和欧洲视觉模拟量表（EQ-VAS）测量的从手术前到出院时HRQOL的变化，以及身体功能（从椅子上站起的能力、通常的步态速度和握力）。次要终点是90天再入院率、术后并发症和住院时间。使用倾向评分进行逆概率加权的多变量回归估计健康素养与预后之间的关联。
在97名患者（36名[37.1%]女性，平均[标准差]年龄74.4[6.3]岁）中，42名（43.3%）报告健康素养低下。在基线时，健康素养低下的患者在EQ-5D-5L评分（P = 0.001）、EQ-VAS值（P = 0.03）、从椅子上站起的能力（P = 0.001）和步态速度（P = 0.03）方面比对照组差。健康素养低下与握力下降风险低相关（风险比，0.13；95%置信区间，0.12 - 0.99），但与其他任何预后均无关。
在接受PRP的腹部肿瘤患者中，健康素养与手术预后似乎没有明显关联。因此，当与PRP结合时，健康素养可能不是手术预后的关键预测因素。
