The effect of musculoskeletal health literacy on 90-day ED return, readmissions, and postoperative adherence following primary total shoulder arthroplasty

Abstract Background The impact of limited health literacy on patient adherence with postoperative instructions, in addition to the utilization of healthcare resources following elective shoulder surgery, remains discordant within the existing literature. Methods We retrospectively reviewed the electronic health records (EHR) for patients who underwent elective total shoulder arthroplasty (TSA) at a single institution. Baseline demographics including age, gender, prior ipsilateral or contralateral shoulder surgery, implant type, and preoperative emergency department (ED) visit within 12 months were collected. Musculoskeletal health literacy (MHL) was assessed using the validated 9-item Literacy in Musculoskeletal Problems (LiMP) questionnaire. All-cause 90-day ED return and readmission was tabulated. Postoperative adherence with return for follow-up and adherence with surgeon instructions regarding motion and sling use was prospectively recorded. Results There were 226 cases included, of which 148 (65%) were female. The median age for the cohort was 67.5 years (IQR 60,73) and 42 (19%) patients had undergone a prior contralateral TSA. Sixty (27%) patients demonstrated adequate MHL (AMHL). On multivariable analysis, limited MHL (LMHL) demonstrated a significant association with 90-day postoperative ED return (OR 3.59, 95% CI 1.17-10.95, P=0.025). Health literacy, however, was not associated with 90-day all-cause readmissions, overall adherence or adherence with postoperative surgeon instructions regarding shoulder motion or sling use (all P>0.05). Conclusions The prevalence of LMHL prior to elective TSA remains high. Assessing LMHL prior to elective TSA could reduce unnecessary healthcare utilization patterns including the risk for postoperative 90-day ED return.