Spine Surgery Outcomes in Patients With Limited English Proficiency.

Abstract

Study design: Retrospective cohort study.

Objective: The purpose of this study is to investigate the impact of language-discordant spine care. Specifically, do non-English speakers (NES) experience (1) increased length of stay? (2) increased rates of complications (ie, intra/perioperative complications, revision surgery, reoperation)?

Background: To provide the best care, there exists a growing focus on understanding which patient groups may be at greater risk for poorer outcomes. In the current body of orthopedic and spine literature, there is little data regarding outcomes for patients where there is language discordance between the physician and patient.

Patients and methods: This is a retrospective cohort study. Patients who underwent spine surgery at a single institution between 2017 and 2023 were included. Translator usage was used as a proxy for poor English language proficiency. Patient demographic and outcome data were collected from the electronic medical record. Patients were matched on surgical and demographic factors and analyzed for outcome variables. Multivariable logistic regressions were run to assess variables associated with poor outcomes.

Results: A total of 214 NES and 9217 English speakers (ES) were reviewed. The final matched cohort resulted in 158 NES and 313 ES with no differences in demographic data. NES patients had significantly more postoperative visits (2.19 vs 1.73; P < 0.001) and increased readmission rates (0.96% vs 4.43%; P = 0.033). On multivariable analysis, NES were predictive of readmission (OR = 4.22; P = 0.039).

Conclusion: Patients with low English proficiency experienced significantly higher rates of readmissions following spine surgery. These patients may benefit from increased and more effective preoperative and postoperative communication.

Level of evidence: Level IV.