The association of primary language with outcomes after cancer operations at a single tertiary referral center and safety net hospital.
*Frederick A Godley IV, *Timothy Feeney, *Christine Park, *Michael R Cassidy, *Teviah E Sachs, David McAneny, Jennifer F Tseng, *Frederick T Drake
Boston University School of Medicine, Boston, MA
Objective: To determine whether a difference in outcomes exists for non-English-speaking patients compared to English-speaking patients after operations commonly performed to treat cancer. We hypothesized that language discordance between providers and patients was an independent risk factor for worse outcomes.
Design: Retrospective cohort study (January 2012 to December 2017). Operations were identified based on current procedural terminology code. Logistic and negative binomial regression were used to adjust for baseline comorbidities, case risk, and socioeconomic factors. Cox proportional hazard modeling was used to evaluate mortality.
Setting: Urban, tertiary referral and safety-net hospital.
Patients (or Other Participants): Adult patients were stratified as English-speaking (ENG), Spanish/Creole-speaking (SpCr), or Non-English, Non-Spanish/Creole speaking (NENS).
Interventions (if any): N/a
Main Outcome Measure(s): 30-day readmission, length of stay (LOS), and all-cause mortality
Results: 2470 patients were included. Most operations were low risk (87.2%) and there was no difference in case risk between language groups. Patients in non-English groups were more likely to be uninsured/self-pay and lived in neighborhoods with lower median income. After adjustment we found no difference in the odds of readmission for SpCr vs ENG (Odds Ratio 1.00, 95%CI [0.65-1.52] ) or NENS vs ENG (1.36 [0.85-2.12]). There was no difference in LOS. Among patients who died, there was no difference in the hazard of mortality: SpCr vs ENG (HR (2.07 [0.91-4.72]), NENS vs ENG (1.29 [0.51-3.29]).
Conclusions: We found no association between language and outcomes after cancer operations. This lack of difference may reflect system-level efficacy at treating non-English speaking patients. It may also suggest that communication barriers do not have an independent impact on the outcomes measured here. Other outcomes, e.g., patient satisfaction, might show different results.
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