Association Between English Proficiency and Postoperative Pain Management for Adult Patients Undergoing Gynecologic Surgery: A Retrospective Cohort Study.

Abstract

Purpose: To determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery.

Design: A retrospective cohort study was performed.

Methods: The electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest.

Findings: All patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance.

Conclusions: Language barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted.