The Need for an Interpreter Increases Length of Stay and Influences Postoperative Disposition Following Primary Total Joint Arthroplasty

Bernstein, Jenna A.; Sharan, Mohamad; Lygrisse, Katherine A.; Lajam, Claudette M.

doi:10.1016/j.arth.2020.04.083

Cited by 16 publications

(30 citation statements)

References 13 publications

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“…Similarly, Stone et al 15 reported a greater LOS for African-American patients undergoing TKA compared to patients of other racial backgrounds. 15 Furthermore, Bernstein et al 40 showed that TJA patients who are non-English speaking and require a translator have a significant increase in LOS when compared to primary English speakers and are more likely to be discharged somewhere other than home. Some patients who were included in our African-American population may be less likely to speak English as a first language, contributing as a potential confounder to the observed increased length of stay in this study cohort.…”

Section: Discussionmentioning

confidence: 99%

Does racial background influence outcomes following total joint arthroplasty?

Singh

Realyvasquez

Kugelman

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: The purpose of this study is to assess whether racial differences influence patient-reported outcome measures (PROMs) following primary total hip (THA) and knee (TKA) arthroplasty. Methods: We retrospectively reviewed patients who underwent primary THA or TKA from 2016 to 2020 with available PROMs. Both THA and TKA patients were separated into three groups based on their ethnicity: Caucasian, African-American, and other races. Patient demographics, clinical data, and PROMs at various time-periods were collected and compared. Demographic differences were assessed using chisquare and ANOVA. Univariate ANCOVA was utilized to compare outcomes and PROMs while accounting for demographic differences. Results: This study included 1999 THA patients and 1375 TKA patients. In the THA cohort, 1636 (82%) were Caucasian, 177 (9%) were African-American, and 186 (9%) were of other races. In the TKA cohort, 864 (63%) were Caucasian, 236 (17%) were African-American, and 275 (20%) were of other races. Surgicaltime significantly differed between the groups that underwent THA (88.4vs.100.5vs.96.1; p < 0.001) with African-Americans requiring the longest operative time. Length-of-stay significantly differed in both THA (1.5vs.1.9vs.1.8; p < 0.001) and TKA (2.1vs.2.5vs.2.3; p < 0.001) cohorts, with African-Americans having the longest stay. Caucasians reported significantly higher PROM scores compared to non-Caucasians in both cohorts. All-cause emergency-department (ED) visits, 90-day postoperative events (read-missions&revisions), and discharge-disposition did not statistically differ in both cohorts. Conclusion: Non-Caucasian patients demonstrated lower PROM scores when compared to Caucasian patients following TJA although the differences may not be clinically relevant. LOS was significantly longer for African-Americans in both THA and TKA cohorts. Further investigation identifying racial disparity interventions is warranted.

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Section: Discussionmentioning

confidence: 99%

Does racial background influence outcomes following total joint arthroplasty?

Singh

Realyvasquez

Kugelman

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…While areas following continental migration such as the Southwest tend to have higher needs for interpreted services, greater than one in seven patients undergoing TKA in a single New York medical center required an interpreter for their visit. 37 However, in an analysis of 50 orthopedic surgery practices, Greene et al found that 80% of the time Spanish-speaking patients were asked to rely on a non-qualified interpreter (family or friends) 38 because of lack of an available interpreter. In addition to a lack of in-visit language support, an analysis of all centers nationwide with pediatric orthopedic surgery fellowships recognized by the Pediatric Orthopaedic Society of North America found only sixteen centers (34.8%) had online information on orthopedic conditions or surgical care translated into Spanish.…”

Section: Discussionmentioning

confidence: 99%

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Markes

Pareek

Mesfin

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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Introduction The literature has consistently demonstrated utilization disparities in joint replacement procedures, though no studies have evaluated disparities in total shoulder arthroplasty with regard to operative volume. Methods We queried the New York (NY) Statewide Planning and Research Cooperative System (SPARCS) database for 32 410 total shoulder arthroplasties performed between 2009 and 2017. Patients were identified using Clinical Classifications Software code 154 for Non-Hip/Knee Arthroplasty and All Patient Refined-Diagnosis Related Group code 322 for Shoulder. Racial groups included Hispanic, non-Hispanic white, non-Hispanic black, and Other. High-volume centers were facilities that performed 2 standard deviations above the mean annual procedures. Utilization rates were calculated by dividing total shoulder arthroplasties per group by the 2010 NY Census population of that group. The Fisher exact test was used to determine significance. Results Total shoulder arthroplasty utilization increased from 43/100 000 to 73/100 000, two-thirds of which was driven by an increase in white resident utilization. More White residents per 100 000 underwent shoulder arthroplasty than Black, Hispanic, and Other residents per 100 000 residents of their respective race. White residents were 90% more likely than Hispanic residents to undergo total shoulder arthroplasty at high-volume centers ( P = .04). There were no differences in utilization rate regarding operative volume comparing Black or Other residents to White residents. More females underwent total shoulder arthroplasty than males, though there was no difference in utilization rate regarding operative volume. Conclusion Though total shoulder arthroplasty utilization nearly doubled, disparities persisted across gender and minority groups particularly in Hispanic utilization as White residents were 90% more likely than Hispanic residents to undergo shoulder arthroplasty at high-volume centers.

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“…We found that patients who required an interpreter were more likely to be discharged to facilities rather than home after TSA. Similarly, Bernstein et al [2] found that non–English-speaking patients were discharged to facilities rather than home more frequently than English-speaking patients after both TKA and THA. Previous literature has reported that patients who required an interpreter after TKA experienced worse functional outcomes compared with their English-speaking counterparts [6]; whether this may also be applicable to patients undergoing TSA is worthy of further study.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are in accordance with previous literature suggesting that patients' limited English language proficiency may be linked to worse outcomes. Bernstein et al [2] performed a retrospective cohort study of primary THA and TKA patients who required a language interpreter and those whose primary language was English and found a significantly longer mean hospital LOS for patients who required an interpreter who underwent THA (1 day longer on average) but not TKA. They suggested that this effect was likely the result of communication disruptions that could be attributed to a language barrier.…”

Section: Discussionmentioning

confidence: 99%

“…A report from 2015 estimated that as of 2013, a total of 25.1 million individuals in the United States had limited English language proficiency [21]. Bernstein et al [2] reported that patients requiring an interpreter experienced significantly longer hospital LOS and were less likely to be discharged home following total hip arthroplasty (THA) and total knee arthroplasty (TKA), despite widely available interpreter services. Given the increasing surgical volume of TSA as well as the growing importance of value-based care and alternative payment models, it is imperative to understand whether similar relationships exist for patients undergoing TSA.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study

Kunze

Estrada

Apostolakos

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. Purpose: We sought to investigate the potential association between TSA patients’ use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. Results: Forty-one patients were included in each cohort, exceeding the minimum number required per an a priori power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort ( n = 8 [19.5%] vs n = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. Conclusions: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge.

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The Need for an Interpreter Increases Length of Stay and Influences Postoperative Disposition Following Primary Total Joint Arthroplasty

Cited by 16 publications

References 13 publications

Does racial background influence outcomes following total joint arthroplasty?

Does racial background influence outcomes following total joint arthroplasty?

Racial and Gender Shoulder Arthroplasty Utilization Disparities of High- and Low-Volume Centers in New York State

Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study

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