title: The impact of health literacy in the care of surgical patients: a qualitative systematic review.
abstract: BACKGROUND
  Inadequate health literacy affects more than 90 million Americans and it has been associated with adverse outcomes in the medicine field including increased hospitalization rates and greater mortality. Since surgical patients are often required to make complex decisions and adhere to complex instructions, health literacy may have a profound impact in the surgical practice. The main objective of the current study was to systematically evaluate the role of health literacy in surgical patients.
  
  
  METHODS
  A systematic search was performed to identify studies that evaluated the role of health literacy in the perioperative setting following the PRISMA guidelines. Only studies that examined health literacy using a validated instrument in the perioperative setting were included.
  
  
  RESULTS
  Ten studies including data on 1147 patients were included. The median (IQR) number of patients in the included studies was 101 (30 to 152). The majority of studies used the Short Test of Functional Literacy in adults (STOFHLA) to evaluate patients' health literacy. Five studies evaluated the patients preoperatively, four studies evaluated patients in the postoperative period and in one study the time of evaluation in relation to the surgical procedure was not defined. The lowest prevalence of inadequate health literacy was detected in kidney transplant patients, 6 out of 124 (5 %), while the highest prevalence of inadequate health literacy was detected in orthopedic patients having total joint replacement, 86 out of 126 (60 %). Inadequate health literacy in the preoperative period was associated with poor medical information comprehension and it may adversely affect adherence to preoperative medications and even modulate surgical disparities. Inadequate health literacy in the postoperative period was associated with poor comprehension of discharge instructions and worse kidney function in transplant recipients.
  
  
  CONCLUSIONS
  Health literacy seems to have a very significant impact in the care of surgical patients. More studies to establish the impact of poor health literacy on perioperative outcomes are needed.
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA. g-jr@northwestern.edu.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.affiliation: Center for Health Care studies, Northwestern University, Chicago, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Holl
mesh_terms: D032882:Comprehension; D057220:Health Literacy; D006801:Humans; D007258:Informed Consent; D010349:Patient Compliance; D019990:Perioperative Care; D036301:Qualitative Research