C. U. Gainous1, S. Rahman2, S. Osman3,4, M. S. Pichardo5,6, N. Khubchandani7, L. Maurer8,9, B. Allar3,4, R. Bergmark3,10,11, G. Ortega3 1Fordham University,New York, NY, USA 2Case Western Reserve University School Of Medicine,Cleveland, OH, USA 3Center for Surgery and Public Health,Department Of Surgery, Brigham And Women’s Hospital, Harvard Medical School,Boston, MA, USA 4Beth Israel Deaconess Medical Center,Department Of Surgery,Boston, MA, USA 5Yale School of Public Health,New Haven, CT, USA 6Howard University College Of Medicine,Washington, DC, USA 7Albany Medical College,Albany, NY, USA 8Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 9Massachusetts General Hospital,Codman Center For Clinical Effectiveness In Surgery,Boston, MA, USA 10Brigham And Women’s Hospital,Division Of Otolaryngology-Head And Neck Surgery, Department Of Surgery,Boston, MA, USA 11Harvard Medical School,Department Of Otolaryngology-Head And Neck Surgery,Boston, MA, USA
Introduction: In 2017, more than 65 million people in the US spoke a language other than English at home. Of these, 37% had Limited English Proficiency (LEP). The language barrier between patients with LEP and language discordant providers poses significant challenges to providing quality care for this population. Previous studies on medical outcomes for patients with LEP have identified disparities in satisfaction of care, medical errors and length of stay. However, the impact of LEP on surgical outcomes is understudied. The objective of our study is to compare surgical outcomes between patients with LEP and those proficient in English. We expect patients with LEP to experience worse surgical outcomes.
Methods: A retrospective cohort study utilizing the 2014 HCUP State Inpatient Database (SID) for three states with primary language information – Georgia, Maryland and New Jersey. Patients were included if they were ages 18 to 90 years and underwent a common subspecialty elective procedure (total hip replacement, total knee replacement, cataract surgery, peripheral endovascular interventions), common general surgery elective procedure (appendectomy, hernia repair, cholecystectomy), elective cancer procedure (breast, colorectal, lung, prostate), elective bariatric procedure, or emergency surgery procedure. To dichotomize patients as LEP and non-LEP, we used a primary language other than English as a proxy for LEP. We used linear and logistic regression techniques to compare LEP and non-LEP outcomes including surgical mortality, length of stay and hospital readmission.
Results: A total of 156,139 patients underwent one of the specified procedures (mean age 60.8 years, SD 15.7; 44.7% male, 55.3% female), of which 4.1% (n=6,418) we considered to be LEP. Patients with LEP were associated with longer length of stay (0.43 days longer, 95% CI 0.22, 0.65, p<0.001) than non-LEP patients and this association remained on adjusted analysis (0.45 days longer, 95% CI 0.20, 0.69, p<0.001). LEP is also associated with lower odds of readmission (Odds Ratio (OR) 0.74, 95% CI 0.62, 0.90, p 0.002). For procedure-group analysis, LEP is associated with higher odds of mortality (OR 3.09, 95% CI 1.12, 8.50, p 0.029) and longer length of stay (0.41 days longer, 95% CI 0.24, 0.54, p <0.001) for elective subspecialty surgery. Patients with LEP undergoing emergency surgery were associated with lower odds of mortality (OR 0.638, 95% CI 0.51, 0.80, p <0.001), lower odds of readmission (OR 0.54, 95% CI 0.45, 0.66, p <0.001), and shorter length of stay (1.22 days shorter, 95% CI -1.54, -0.89, p <0.001).
Conclusion: Substantial differences in surgical outcomes exist between patients with LEP and patients that are English proficient. Patients with LEP have worse outcomes for elective subspecialty surgery compared to patients without LEP, but better outcomes for emergency surgery. Further research is needed to examine factors that may mediate this association.