Effect of Limited English Proficiency on Outcomes Following Cancer Operations
*Timothy Feeney, *Michael Cassidy, David McAneny, Maureen Kavanah, *Teviah Sachs, Jennifer F. Tseng, *Frederick Thurston Drake
Boston Medical Center/Boston University, Boston, MA
Objective:Determine if limited English proficiency affects outcomes following cancer operations.
Design:Retrospective cohort study (HCUP New Jersey Statewide Inpatient Database)
Setting: New Jersey, Jan 1, 2009-Dec 31, 2014.
Patients: Patients ≥ 18 years undergoing breast, pancreas, biliary, stomach, liver, thyroid, or adrenal operations.
Main Outcome Measures: Odds ratio (OR) of 30-day mortality, 7-day readmission, length of stay (LOS).
Results: 35,709 cases were analyzed. 3,228 (9.0%) patients reported non-English primary language. Non-English speakers were substantially less likely to be insured than were English speakers (6.5% vs. 23.6%, p<0.001). Co-morbid conditions were similar in prevalence except for a slight increase in mental illness and lung disease among English-proficient patients. Overall mortality was 1.8%, and when adjusted for demographics, comorbidities, and socioeconomic factors (income and insurance status) there was no difference in 30-day mortality (OR 0.97 [95%CI:0.70-1.35]) regardless of language. Overall, the odds of readmission did not differ by primary language; however, the effect of language varied by race. Compared to white patients, English proficient non-black minorities were less likely to be readmitted (0.79 [95%CI:0.65-0.97]), but there was no difference (versus white patients) for non-black minorities who were not English proficient or for black patients regardless of language proficiency. Median LOS increased by 0.58 days (95%CI: 0.37-0.78 days) in non-English proficient patients.
Conclusions: English proficiency does not have an independent effect on 30-mortality or readmission following cancer operations, and patients are not more likely to be readmitted based upon language. Patients with a non-English primary language stayed in the hospital over a half-day longer. These results suggest that mortality and early complications are not impacted by English proficiency, but discharge timing may be potentially impacted by language barriers.