Association of Language Barriers With Perioperative and Surgical Outcomes

Abstract

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.

Prohibiting Babel - A call for professional remote interpreting services in pre-operation anaesthesia information

“…Given our study design and participant numbers, such granular effects could not have been detected. Nonetheless, we observed moderate to large effects for our main variables (for which the study was statistically well powered), and our study results are cross-validated by other language barrier studies (5,14,32,34,64).…”

“…Compared to lay interpreters, using professional interpreters significantly improves the uptake of critical information about general anaesthesia. It is therefore first and foremost an ethical imperative to act on these outcomes, as improved information transfer is directly linked to better clinical outcomes (1,7,14,16,19,65). Consequently, it increases patient safety.…”

“…Importantly, in addition to the legal ramifications, it is well-established that language barriers are associated with several negative outcomes. Patient safety, healthcare routines, patient and healthcare professional satisfaction, patient compliance, and access to health care are all negatively affected when communication and understanding cannot be properly established (14)(15)(16)(17)(18)(19). Additionally, problems in understanding can be linked to higher costs as language barriers result in the use of more expensive tertiary health services rather than primary services, multiple visits to physicians, and longer hospital stays (5,(20)(21)(22).…”

Challenges in Assessment and Management of Postoperative Agitation and Delirium in a Stroke Patient with Limited English Proficiency: Case Report

“…3 The Table summarizes findings from recent systematic reviews on the impact of LEP status on perioperative outcomes. 2,3…”

“…Approximately 26 million people in the United States have limited English proficiency (LEP), or a restricted ability to “read, speak, write or understand English.” 1 Language barriers between health care providers and patients are associated with adverse health outcomes and perceived poor quality care. 2,3 Within the intensive care unit (ICU), effective communication is critical given changing clinical conditions and need for timely treatment decisions. While Title VI of the Civil Rights Act of 1964 mandates professional medical interpreter (PMI) use, significant disparities persist for patients with LEP.…”