Primary Language as a Predictor of Perioperative Opioid Consumption and Clinical Outcomes in Breast Reconstruction: A Retrospective Cohort Study.

Abstract

Introduction: Language barriers can impair communication and affect perioperative outcomes. This study examines the perioperative impact of limited English proficiency (LEP) on opioid consumption for pain management and clinical outcomes in both autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). Methods: A retrospective cohort study (2019-2023) utilized electronic health records to categorize breast reconstruction patients by primary language proficiency. Outcomes included opioid consumption (postoperative and total morphine milligram equivalents [MME]), complications, reoperations, emergency department visits, and readmissions. Analyses used comparative tests and multivariate regressions. Subgroup analyses were conducted for reconstruction type. Results: Among 1706 patients (15% non-English-speaking), non-English speakers demonstrated significantly lower postoperative (58 ± 77 vs 88 ± 121, p < .001) and total (166 ± 121 vs 207 ± 146, p < .001) opioid consumption, with Cantonese speakers having the lowest odds of opioid consumption. In ABR, non-English speakers had reduced postoperative (74 ± 89 vs 115 ± 147, p < .001) and total (203 ± 126 vs 256 ± 166, p < .001) opioid requirements (β= -40, p = .026) but higher odds of seroma formation (OR = 2.78, p = 0.030). In IBR, non-English speakers similarly used fewer opioids postoperatively (28 ± 35 vs 56 ± 70, p < .001) and in total (98 ± 73 vs 152 ± 94, p < .001), and also demonstrated increased odds of seroma formation (OR = 4.66, p = .018). Conclusion: Language proficiency is associated with differences in opioid consumption and clinical outcomes following breast reconstruction. These findings underscore the importance of considering language barriers when designing pain management strategies for patients with LEP.