Non-English Primary Language is Associated with Emergency Surgery for Diverticulitis

Maurer, Lydia R.; Allar, Benjamin G.; Perez, Numa P.; Witt, Emily E.; Uribe-Leitz, Tarsicio; Peck, Gregory; Bergmark, Regan W.; Bates, David W.; Ortega, Gezzer

doi:10.1016/j.jss.2021.07.042

Cited by 12 publications

(30 citation statements)

References 22 publications

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

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Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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ImportanceEnglish language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.ObjectiveTo examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.Evidence ReviewA systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.FindingsOf 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.Conclusions and RelevanceIn this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were observational, and 26 of 29 studies were retrospective. All were cohort studies except for 1 cross-sectional study.…”

Section: Resultsmentioning

confidence: 99%

Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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“…Our study additionally found that LEP patients trended toward higher ASA ratings (higher burden of medical comorbidities before surgery) and were much more likely to undergo urgent rather than elective surgery, findings in line with previous studies demonstrating associations between LEP and more advanced disease at presentation and increased likelihood of emergency surgery. 14,15 Indeed, in multivariable analysis, urgent presentation and higher ASA rating were associated with longer LOS, higher cost, and discharge to skilled care. Despite adjusting for these confounders in the multivariable analysis, however, LEP itself remains an independent risk factor of prolonged LOS, increased discharge to skilled care, and increased health care costs.…”

Section: Discussionmentioning

confidence: 95%

Association of Language Barriers With Process Outcomes After Craniotomy for Brain Tumor

et al. 2022

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BACKGROUND:Little is known about the independent association of language barriers on postoperative process outcomes after craniotomies.OBJECTIVE:To evaluate the association of limited English proficiency (LEP) with length of stay (LOS), discharge disposition, hospitalization costs, and rate of 30-day readmission after craniotomy for brain tumor.METHODS:This is a retrospective cohort study of adult patients who underwent craniotomies for brain tumor from 2015 to 2019 at a high-volume neurosurgical center. Multivariable logistic regression was used to evaluate the association of LEP with discharge disposition and 30‐day readmission. Negative binomial regression was used to evaluate the association of LEP with LOS and hospitalization cost.RESULTS:Of the 2232 patients included, 7% had LEP. LEP patients had longer LOS (median [IQR] 5 [3-8] days vs 3 [2-5] days, P < .001), higher costs of hospitalization (median [IQR] $27 000 [$21 000-$36 000] vs $23 000 [$19 000-$30 000], P < .001), and were more likely to be discharged to skilled care facilities (37% vs 21%, P < .001) compared with English proficient patients. In multivariable models, the association between LEP and longer LOS (incidence rate ratio 1.11, 95% CI 1.00-1.24), higher hospitalization costs (incidence rate ratio 1.13, 95% CI 1.05-1.20), and discharge to skilled care (OR 1.76, 95% CI 1.13-2.72) remained after adjusting for confounders. There was no difference in 30-day readmission rates by language status.CONCLUSION:LEP is an independent risk factor for extended LOS, higher hospitalization cost, and discharge to skilled care in neurosurgical patients who undergo craniotomy for brain tumor. Future research should seek to understand mediators of these observed disparities.

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“…This study identified that non‐English speakers had a lower rate of DLI closure at the 6‐month mark compared to English speaking patients (7.7% vs. 36.8%, P = 0.028). A non‐English primary language has been found to be risk factor with regard to access to elective surgery in diverticular disease 34 as well as a risk factor for delayed treatment in breast cancer care 35 . Qualitative data from colorectal cancer survivors demonstrates that non‐English speaking patients experience a perception of discrimination in accessing healthcare 36 .…”

Section: Discussionmentioning

confidence: 99%

Causes and costs of delayed closure of ileostomies in rectal cancer patients in Australasian units

Barnard

Milne

Teo

et al. 2022

ANZ Journal of Surgery

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Background Defunctioning loop ileostomies (DLIs) are a frequent adjunct to rectal cancer surgery. Delayed closure of DLIs is common and associated with increased morbidity. The reasons for delayed DLI closure are often unknown. The economic burden of delayed DLI closure is not quantified. The present study aimed to determine the reasons for, and economic burden of, delayed DLI closure. Methods Clinical and economic data were audited from a prospective database of patients in two Australasian colorectal cancer centres. Patients treated at each unit with low/ultra‐low anterior resection for rectal cancer with formation of DLI between January 2014 and December 2019 were included. Post‐operative complication rate, stoma‐related complication rate and costs of hospital admissions and stoma care were recorded and analysed. Multivariate linear regression analysis was used to investigate risk factors for delay to closure. Results 146 patients underwent low/ultra‐low anterior resection with DLI; 135 patients (92.5%) underwent reversal. The median duration to reversal was 7 months (IQR 4.5–9.5). Sixty‐six percent of patients underwent reversal >6 months after their index surgery. Neoadjuvant and adjuvant chemotherapy were associated with delayed reversal (P < 0.001). Non‐English speakers waited longer for DLI closure (P = 0.028). The costs of outpatient stoma care (P < 0.001), post‐operative care (P = 0.004), and total cost of treatment (P = 0.014) were significantly higher in the delayed closure group, with a total cost of treatment difference of $3854 NZD per patient. Conclusions Causes of delay include systemic factors and demographic factors that can be addressed directly, addressing such causes may alleviate a significant economic burden.

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Non-English Primary Language is Associated with Emergency Surgery for Diverticulitis

Cited by 12 publications

References 22 publications

Association of Language Barriers With Perioperative and Surgical Outcomes

Association of Language Barriers With Perioperative and Surgical Outcomes

Association of Language Barriers With Process Outcomes After Craniotomy for Brain Tumor

Causes and costs of delayed closure of ileostomies in rectal cancer patients in Australasian units

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