Associations Between Patients' Primary Spoken Language and Perioperative Outcomes After Hip Fracture.

Abstract

Introduction: Recently, the role of a patient's primary spoken language (PSL) has emerged as a potential contributor to perioperative outcomes. This study aimed to identify the association between a patient's PSL and hip fracture perioperative outcomes, including hospital length of stay (LOS), in-hospital mortality, nonhome discharge, 30-day emergency department visits, 90-day readmissions, and 90-day complications.

Methods: An institutional review board-approved retrospective cohort study was performed using institutional data. Two cohorts were created for patients who underwent either open reduction and internal fixation (ORIF) or arthroplasty (total or hemiarthroplasty) for a hip fracture in 2016 to 2023 in a multihospital academic health system. Within each cohort, patients with non-English and English PSL were matched 1:3 based on age, sex, insurance, American Society of Anesthesiologists Classification, dementia, and obesity. Generalized linear models measured associations between PSL and outcomes, adjusting for Charlson Comorbidity Index; adjusted odds ratios are reported for binary outcomes and adjusted mean differences are reported for continuous outcomes.

Results: The matched cohorts included 729 patients undergoing ORIF and 473 undergoing arthroplasty. In multivariable analyses in the ORIF cohort, non-English PSL (versus English) was associated with a markedly longer LOS by an average of 0.95 days (95% confidence interval [CI], 0.28 to 1.62, P = 0.01) and decreased likelihood of discharge to a nonhome setting (odds ratio = 0.62, 95% confidence interval, 0.39 to 0.98, P = 0.04). For arthroplasty, non-English PSL (versus English) was markedly associated with shorter LOS by an average of 1.04 days (95% CI, -1.99 to -0.09, P = 0.03). No notable associations were identified between PSL and the other outcomes.

Conclusion: These findings suggest language-based differences in perioperative outcomes for surgical management of hip fracture. Further research is needed to identify the mechanisms of these associations and evaluate the clinical significance on long-term outcomes.