E. Bakillah1, J. Sharpe1, J. Tong1, M. Goldshore1, J. Morris1, R. Kelz1 1Hospital Of The University Of Pennsylvania, Surgery, Philadelphia, PA, USA
Introduction: Patients with a non-English primary language may experience barriers to accessing healthcare in the United States. Little is known about the relationship between primary language status and surgical care. We sought to examine access to surgical care among patients who speak a primary language other than English using a cholecystectomy model.
Methods: We performed a retrospective cohort study of adults age ≥18 years discharged following a cholecystectomy in Michigan, Maryland, and New Jersey utilizing the Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery and Services Database, 2016-2018. Patients with cirrhosis and hepatobiliary malignancy were excluded. Patients were classified by their primary spoken language: English or non-English. The primary outcome was type of admission (emergent vs elective). Secondary outcomes included operative approach (minimally invasive vs open) and setting (inpatient vs outpatient). Multivariable logistic regression was used to examine outcomes with adjustment for potential confounders.
Results: Among 122,013 adult cholecystectomy patients, 111,813 (91.6%) were primarily English speaking and 10,200 (8.4%) spoke a non-English primary language. Patient characteristics differed by primary language spoken (Table 1). In models adjusted for potential confounders, primary non-English speaking patients had a higher likelihood of emergent/urgent admissions (OR 1.22, 95% CI 1.04-1.44, P=0.015). Similarly, primary non-English speaking patients had a lower likelihood of having an outpatient operation (OR 0.80, 95% CI 0.70-0.91, P=0.0008). In contrast, there was no difference in use of minimally invasive approach based on primary language spoken (English: 99.8%, Non-English: 99.9%).
Conclusion: On average, patients with non-English primary languages appeared healthier and younger. However, despite their healthier status they were more likely to access surgical care via the emergency department and less likely to receive outpatient cholecystectomy. Barriers to elective surgical presentation for this unique patient population needs to be further studied.
