Nonclinical Barriers to Care for Neurogenic Patients Undergoing Complex Urologic Reconstruction

Abstract

OBJECTIVE: To identify nonclinical factors affecting postoperative complication rates in patients with neurogenic bladder undergoing benign genitourinary (GU) reconstruction. METHODS: Adult patients with neurogenic bladder undergoing benign GU reconstruction between October 2010 and November 2015 were included. Patients were excluded if a diversion was performed for malignancy, if patients had a history of radiation or if a new bowel segment was not utilized at the time of the operation. Clinical and nonclinical factors were abstracted from the patients’ electronic medical records. Health literacy was assessed via the Brief Health Literacy Screen (BHLS), a validated 3-question assessment. Education, marital status, and distance from the medical center were also queried. RESULTS: Forty-nine patients with a neurogenic bladder undergoing complex GU reconstruction met inclusion and exclusion criteria. On average, patients lived 111 miles (standard deviation 89) from the hospital. Overall, mean BHLS score was 10.4 (standard deviation 4.6) with 35% of patients scoring a BHLS of ≤9. Mean years of educational attainment was 9.7, and only 31% of patients completed high school education. In the first month after surgery, 37 patients (76%) experienced a complication, and 22% were readmitted; however, analysis of complication data did not identify an association between any nonclinical variables and complication rates. CONCLUSION Nonclinical factors including unmarried status, poor health literacy, and marked distance from quaternary care are prevalent in patients with neurogenic bladder undergoing complex GU reconstruction. To mitigate these potential risk factors, the authors recommend acknowledgment of these factors and multidisciplinary support perioperatively to counteract them.

Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review

“…Following the selection process, five articles were included in the review. All studies were conducted in the US, published between 2014 and 2018 in peer-reviewed journals, and had an observational descriptive design that, in three cases, was not explicitly reported ( Cawthon, Mion, Willens, Roumie, & Kripalani, 2014 ; Sosland et al, 2019 ; Wright et al, 2018 ). In three studies, the main objective was to implement an HL instrument in patients’ electronic documentation to verify its feasibility ( Cawthon et al, 2014 ; Sand-Jecklin, Daniels, & Lucke-Wold, 2017 ; Warring et al, 2018 ).…”

“…In three studies, the main objective was to implement an HL instrument in patients’ electronic documentation to verify its feasibility ( Cawthon et al, 2014 ; Sand-Jecklin, Daniels, & Lucke-Wold, 2017 ; Warring et al, 2018 ). One study aimed at evaluating the association between HL and postoperative outcomes ( Wright et al, 2018 ), and the remaining study evaluated some factors, including HL related to postoperative complication rates ( Sosland et al, 2019 ).…”

“…All studies were classified as high quality ( Lu et al, 2020 ), and they all described the setting and relevant dates, clearly identified and reported all the outcomes, summarised the key results with reference to study objectives and gave an interpretation of the results. Four studies reported the participants’ characteristics ( Cawthon et al, 2014 ; Sosland et al, 2019 ; Warring et al, 2018 ; Wright et al, 2018 ) and discussed the studies’ limitations ( Sand-Jecklin et al, 2017 ; Sosland et al, 2019 ; Warring et al, 2018 ; Wright et al, 2018 ). Only two studies explained the participants’ eligibility criteria ( Sosland et al, 2019 ; Wright et al, 2018 ) and defined the number of individuals at each study stage ( Sand-Jecklin et al, 2017 ; Warring et al, 2018 ).…”

“…Four studies reported the participants’ characteristics ( Cawthon et al, 2014 ; Sosland et al, 2019 ; Warring et al, 2018 ; Wright et al, 2018 ) and discussed the studies’ limitations ( Sand-Jecklin et al, 2017 ; Sosland et al, 2019 ; Warring et al, 2018 ; Wright et al, 2018 ). Only two studies explained the participants’ eligibility criteria ( Sosland et al, 2019 ; Wright et al, 2018 ) and defined the number of individuals at each study stage ( Sand-Jecklin et al, 2017 ; Warring et al, 2018 ). One study described a potential source of bias ( Sosland et al, 2019 ).…”

“…Only two studies explained the participants’ eligibility criteria ( Sosland et al, 2019 ; Wright et al, 2018 ) and defined the number of individuals at each study stage ( Sand-Jecklin et al, 2017 ; Warring et al, 2018 ). One study described a potential source of bias ( Sosland et al, 2019 ). There was no evidence of data generalisability in any of the studies ( Table 3 ).…”