Presentation Details
| Impact of Health Literacy on Postoperative Pain and Opioid Use Following Lower Extremity Arthroplasty Brittany R.Fennell1, Thomas R.Vetter2, T.Mark Beasley3, Amandiy N.Liwo2. 1UAB Marnix E.Heersink School of Medicine, Birmingham, AL, USA.2UAB Department of Anesthesiology and Perioperative Medicne, Birmingham, AL, USA.3UAB School of Public Health Department of Biostatistics, Birmingham, AL, USA |
Abstract
BACKGROUND: Health literacy, the ability to obtain, understand, and use health information, impacts health outcomes but remains understudied in orthopedic surgery. Although some studies have examined postoperative pain or opioid use after total joint arthroplasty, none have evaluated these outcomes in the context of patient health literacy. Low health literacy may distort pain reporting and mask inadequate pain control. This study examined the associations between health literacy, postoperative pain, and opioid use following lower extremity arthroplasty.
METHODS: This retrospective cohort included 358 patients undergoing total knee arthroplasty or total hip arthroplasty and evaluated at the UAB Preoperative Assessment, Consultation, and Treatment Clinic between August 2020 and January 2023. Health literacy was measured using the Brief Health Literacy Screen and categorized as inadequate (<17) or adequate (≥17). Pain scores on a 0-10 numerical rating scale were recorded from preoperative evaluation through 72 hours postoperatively, and opioid use in morphine milligram equivalents was tracked from the post-anesthesia care unit through 48 hours postoperatively. Mixed-effects models assessed differences in pain and opioid use trajectories over time, adjusting for age, sex, race, ASA status, and procedure type.
RESULTS: Of 358 patients, 40 (11.2%) had inadequate health literacy, more often male (62.5% vs 40.3%, p=0.007), Black (60.0% vs 40.9%, p=0.021), and ASA IV score (33.3% vs 1.9%, p=0.025). Mixed-effects modeling demonstrated a significant time × health-literacy interaction for pain (adjusted p=0.003). Patients with inadequate health literacy reported lower mean pain scores at 48 hours (4.3 vs 5.7, p=0.007) and 72 hours (4.3 vs 6.0, p=0.018), despite similar opioid use (p=0.204).
CONCLUSIONS: A “72-hour pain paradox” was identified, as patients with inadequate health literacy reported lower pain despite equivalent opioid use. These findings suggest that differences in health literacy may influence postoperative pain reporting and management after arthroplasty.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: This retrospective cohort included 358 patients undergoing total knee arthroplasty or total hip arthroplasty and evaluated at the UAB Preoperative Assessment, Consultation, and Treatment Clinic between August 2020 and January 2023. Health literacy was measured using the Brief Health Literacy Screen and categorized as inadequate (<17) or adequate (≥17). Pain scores on a 0-10 numerical rating scale were recorded from preoperative evaluation through 72 hours postoperatively, and opioid use in morphine milligram equivalents was tracked from the post-anesthesia care unit through 48 hours postoperatively. Mixed-effects models assessed differences in pain and opioid use trajectories over time, adjusting for age, sex, race, ASA status, and procedure type.
RESULTS: Of 358 patients, 40 (11.2%) had inadequate health literacy, more often male (62.5% vs 40.3%, p=0.007), Black (60.0% vs 40.9%, p=0.021), and ASA IV score (33.3% vs 1.9%, p=0.025). Mixed-effects modeling demonstrated a significant time × health-literacy interaction for pain (adjusted p=0.003). Patients with inadequate health literacy reported lower mean pain scores at 48 hours (4.3 vs 5.7, p=0.007) and 72 hours (4.3 vs 6.0, p=0.018), despite similar opioid use (p=0.204).
CONCLUSIONS: A “72-hour pain paradox” was identified, as patients with inadequate health literacy reported lower pain despite equivalent opioid use. These findings suggest that differences in health literacy may influence postoperative pain reporting and management after arthroplasty.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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