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Godet C, Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Valérie B, Manceau G, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Chautard J, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Desfourneaux-Denis V, Maggiori L, Rebibo L, Niki C, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Pellegrin A, Dejardin O, Alves A. Risk factors for emergency surgery for diverticulitis: A retrospective multicentric French study at 41 hospitals. Surgery 2024; 175:1508-1517. [PMID: 38609785 DOI: 10.1016/j.surg.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/10/2023] [Accepted: 02/06/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The observed increase in the incidence of complicated diverticulitis may lead to the performance of more emergency surgeries. This study aimed to assess the rate and risk factors of emergency surgery for sigmoid diverticulitis. METHOD The primary outcomes were the rate of emergency surgery for sigmoid diverticulitis and its associated risk factors. The urgent or elective nature of the surgical intervention was provided by the surgeon and in accordance with the indication for surgical treatment. A mixed logistic regression with a random intercept after multiple imputations by the chained equation was performed to consider the influence of missing data on the results. RESULTS Between 2010 and 2021, 6,867 patients underwent surgery for sigmoid diverticulitis in the participating centers, of which one-third (n = 2317) were emergency cases. In multivariate regression analysis with multiple imputation by chained equation, increasing age, body mass index <18.5 kg/m2, neurologic and pulmonary comorbidities, use of anticoagulant drugs, immunocompromised status, and first attack of sigmoid diverticulitis were independent risk factors for emergency surgery. The likelihood of emergency surgery was significantly more frequent after national guidelines, which were implemented in 2017, only in patients with a history of sigmoid diverticulitis attacks. CONCLUSION The present study highlights a high rate (33%) of emergency surgery for sigmoid diverticulitis in France, which was significantly associated with patient features and the first attack of diverticulitis.
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Affiliation(s)
- Camille Godet
- Department of Digestive Surgery, University Hospital of Caen, France.
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, France
| | - Mehdi Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary, and Liver Transplant, Trousseau Hospital, University Hospital of Tours, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, France
| | - Bridoux Valérie
- Department of Digestive Surgery, University Hospital of Rouen, France
| | - Gilles Manceau
- Department of Digestive and Oncological Surgery, European Georges Pompidou Hospital, Paris Cité University, AP-HP, Paris, France
| | - Yves Panis
- Colorectal surgery Center, Groupe Hospitalier Privé Ambroise-Paré Hartmann, Neuilly/Seine, France
| | - Etienne Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - Aurélien Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - Iman Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - Martin Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - Manon Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - Alexandre Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | | | - Clarisse Eveno
- Department of Digestive Surgery, University Hospital of Lille, France
| | - Catherine Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - Bogdan Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - Julien Chautard
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, France
| | - Yassine Eid
- 21 Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - Emilie Duchalais
- 22 Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospital Lyon Sud, France
| | - Anaïs Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | | | - Léon Maggiori
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, France
| | - Lionel Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Christou Niki
- Department of Digestive Surgery, Limoges Hospital, France
| | - Ali Talal
- Department of Digestive Surgery, Argentan Hospital, France
| | - Diane Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Cécile Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, France
| | | | | | - Christophe Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Bobigny, Sorbonne Paris Nord University, France
| | - Jean Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - Alexis Laurent
- Department of Digestive Surgery, Créteil Hospital, France
| | - Bertrand Trilling
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France; Department of Digestive Surgery and Emergency, University Hospital of Grenoble, Alpes, France
| | - Martin Bertrand
- Department of Digestive Surgery, University Hospital of Nîmes, France
| | - Damien Massalou
- Department of Digestive Surgery, Hospital L'Archet, Nice University, Nice, France
| | - Benoit Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | | | - Olivier Dejardin
- Department of Research; CHU de Caen, ANTICIPE, Inserm Unity UMR 1086, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, France; Department of Research; CHU de Caen, ANTICIPE, Inserm Unity UMR 1086, France
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Bakillah E, Sharpe J, Tong JK, Goldshore M, Morris JB, Kelz RR. Non-English Primary Language: A Growing Population's Access to Cholecystectomy. Ann Surg 2023; 278:e1175-e1179. [PMID: 37226825 DOI: 10.1097/sla.0000000000005919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To examine access to cholecystectomy and postoperative outcomes among non-English primary-speaking patients. BACKGROUND The population of U.S. residents with limited English proficiency is growing. Language affects health literacy and is a well-recognized barrier to health care in the United States of America. Historically marginalized communities are at greater risk of requiring emergent gallbladder operations. However, little is known about how primary language affects surgical access and outcomes of common surgical procedures, such as cholecystectomy. METHODS We conducted a retrospective cohort study of adult patients after receipt of 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 were classified by primary spoken language: English or non-English. The primary outcome was admission type. Secondary outcomes included operative setting, operative approach, in-hospital mortality, postoperative complications, and length of stay. Multivariable logistics and Poisson regression were used to examine outcomes. RESULTS Among 122,013 patients who underwent cholecystectomy, 91.6% were primarily English speaking and 8.4% were non-English primary language speaking. Primary non-English speaking patients had a higher likelihood of emergent/urgent admissions (odds ratio: 1.22, 95% CI: 1.04-1.44, P = 0.015) and a lower likelihood of having an outpatient operation (odds ratio: 0.80, 95% CI: 0.70-0.91, P = 0.0008). There was no difference in the use of a minimally invasive approach or postoperative outcomes based on the primary language spoken. CONCLUSIONS Non-English primary language speakers were more likely to access cholecystectomy through the emergency department and less likely to receive outpatient cholecystectomy. Barriers to elective surgical presentation for this growing patient population need to be further studied.
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Affiliation(s)
- Emna Bakillah
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, Philadelphia, PA
- Leonard Davis Institute of Health Economics, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
| | - James Sharpe
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, Philadelphia, PA
| | - Jason K Tong
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, Philadelphia, PA
- Leonard Davis Institute of Health Economics, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Matthew Goldshore
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jon B Morris
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Center for Surgery and Health Economics, Philadelphia, PA
- Leonard Davis Institute of Health Economics, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, PA
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Lopez B, Gottlieb BR, Naples JG. Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency. Otolaryngol Head Neck Surg 2023; 169:651-659. [PMID: 37194741 DOI: 10.1002/ohn.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE Limited English proficiency (LEP) is known to contribute to poorer health outcomes and delays in management. However, to our knowledge, no other studies have explored the impact of LEP on delays to care within otolaryngology. This study aims to investigate the relationship between LEP and the time to delivery of otolaryngology care. METHODS We retrospectively reviewed 1125 electronic referrals to an otolaryngologist from primary care providers at 2 health centers in the greater Boston area, between January 2015 and December 2019. Multivariable logistic regression analyses were conducted to determine if patient LEP status (preferred language non-English and language interpreter use) has an impact on total time to appointment (TTTA). RESULTS Patients with non-English preferred languages were 2.6 times more likely to experience extended TTTA (odds ratio [OR] = 2.61, 95% confidence interval [CI] = 1.99-3.42, p < .001) relative to English-speaking patients. Patients who required interpreter use were 2.4 times more likely to experience extended TTTA (OR = 2.42, 95% CI = 1.84-3.18, p < .001) relative to patients who did not require an interpreter. There was no difference in age, sex, insurance type, education level, or marital status. TTTA did not vary by diagnosis category (p = .09). DISCUSSION LEP is an important factor that influences the time to appointment in our cohort. Notably, the impact of LEP on appointment wait times was independent of diagnosis. IMPLICATIONS FOR PRACTICE Clinicians should recognize LEP as a factor that can impact the overall delivery of care in otolaryngology. Specifically, mechanisms to streamline care for LEP patients should be considered.
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Affiliation(s)
- Betzamel Lopez
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Barbara R Gottlieb
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James G Naples
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Joo H, Fernández A, Wick EC, Moreno Lepe G, Manuel SP. Association of Language Barriers With Perioperative and Surgical Outcomes: A Systematic Review. JAMA Netw Open 2023; 6:e2322743. [PMID: 37432686 PMCID: PMC10336626 DOI: 10.1001/jamanetworkopen.2023.22743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/13/2023] [Indexed: 07/12/2023] Open
Abstract
Importance English 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. Objective To examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes. Evidence Review A 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. Findings Of 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 Relevance In 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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Affiliation(s)
- Hyundeok Joo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Alicia Fernández
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Elizabeth C. Wick
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco
| | - Gala Moreno Lepe
- University of California San Francisco School of Medicine, San Francisco
- Now with Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Solmaz P. Manuel
- Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco
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Tong JKC, Mascuilli T, Wirtalla C, Aarons CB, Saur NM, Mahmoud NN, Kelz RR. Exploring ethnic differences in post-discharge patterns of surgical care for older adults admitted with diverticulitis. Colorectal Dis 2023; 25:1006-1013. [PMID: 36655392 PMCID: PMC10257996 DOI: 10.1111/codi.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/11/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
AIM We aimed to evaluate ethnic differences in patterns of care following an index nonoperative admission for acute diverticulitis amongst a universally insured patient cohort. METHODS We identified nationwide Medicare beneficiaries aged 65.5 years or older hospitalized between 1 July 2015 and 1 November 2017 for nonoperative management of an index admission for diverticulitis. Patients were followed for 1 year to examine patterns of care. Primary categorical outcomes included receipt of an elective operation, emergency operation, nonoperative readmission or no further hospitalizations for diverticulitis. Multinomial regression was performed to determine the association between ethnicity and receipt of each primary outcome category whilst adjusting for potential confounders. We examined the use of percutaneous drainage during the index admission to better understand its association with subsequent care patterns. RESULTS Amongst 22 630 study patients, subsequent operative treatment was less common for Black, Hispanic, Asian and American Indian patients relative to White patients. Multinomial logistic regression noted that Black (relative risk 0.40; 95% CI 0.32-0.50) and Asian (relative risk 0.37; 95% CI 0.15-0.91) patients were associated with the lowest relative risk of undergoing an elective interval operation compared to White patients. Black patients were also associated with a 1.43 (95% CI 1.19-1.73) increased risk of requiring subsequent nonoperative readmissions for disease recurrence compared to White patients. The use of percutaneous drainage was higher amongst White patients relative to Black patients (6.9% vs. 4.0%, P value < 0.001). CONCLUSION We have identified ongoing inequities in the consumption of medical resources, with White patients being more likely to undergo elective colectomy and percutaneous drainage. Differences in care are not fully alleviated by equal access to insurance.
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Affiliation(s)
- Jason K C Tong
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinicians Scholars Veterans Affairs Fellow, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tory Mascuilli
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Wirtalla
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cary B Aarons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole M Saur
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Najjia N Mahmoud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barnard J, Milne T, Teo K, Weston M, Israel L, Peng SL. Causes and costs of delayed closure of ileostomies in rectal cancer patients in Australasian units. ANZ J Surg 2023; 93:636-642. [PMID: 36203387 DOI: 10.1111/ans.18092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
- Jon Barnard
- Coloreectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tony Milne
- General Surgery, Nelson Hospital, Nelson, New Zealand
| | - Keith Teo
- General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Maree Weston
- General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Lincoln Israel
- General Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Sze-Lin Peng
- General Surgery, Middlemore Hospital, Auckland, New Zealand
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Are patients with limited English proficiency less likely to undergo parathyroidectomy for primary hyperparathyoidism? Am J Surg 2023; 225:236-241. [PMID: 35717203 DOI: 10.1016/j.amjsurg.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite meeting operative indications for primary hyperparathyroidism (PHPT), many patients never undergo parathyroidectomy. We hypothesized that patients with limited English proficiency (LEP) would be less likely to undergo parathyroidectomy than English-proficient (EP) patients. STUDY DESIGN We retrospectively analyzed patients with PHPT from an institution-wide registry who met operative criteria between 2010 and 2018. The cohort was stratified by English proficiency. Univariate associations between sociodemographic and clinical factors with parathyroidectomy were assessed. A multivariable logistic regression model was created to assess independent predictors of parathyroidectomy. RESULTS Among a cohort of 1,104 patients, 262 (24%) underwent parathyroidectomy. LEP patients (n = 135, 12%) were significantly younger (mean age 62 vs. 69, p < 0.001), more likely non-white race and ethnicity (p < 0.001), and less likely to have private insurance (p < 0.001). After adjusting for covariates, non-English and non-Spanish preferred language was an independent negative predictor of undergoing parathyroidectomy (OR 0.46, 95% CI 0.21-0.95, p = 0.037). CONCLUSIONS Limited English proficiency may be an independent barrier to appropriate surgical management of PHPT. Systems-level and disease-specific interventions are needed to address this disparity faced by patients with LEP.
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Manuel SP, Chia ZK, Raygor KP, Fernández A. Association of Language Barriers With Process Outcomes After Craniotomy for Brain Tumor. Neurosurgery 2022; 91:590-595. [PMID: 35857019 PMCID: PMC10552977 DOI: 10.1227/neu.0000000000002080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
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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Affiliation(s)
- Solmaz P. Manuel
- Department of Anesthesia and Perioperative Care, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Zer Keen Chia
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kunal P. Raygor
- Department of Neurological Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Alicia Fernández
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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