No significant difference in length of stay after bariatric surgery between LEP and EP patients (adjusted IRR 0.94)

Description #

In this retrospective cohort of bariatric surgery patients, there was no significant difference in length of stay (LOS) from the index operation between English-proficient (EP) and limited-English-proficiency (LEP) patients (2.26 days vs 2.12 days; p = 0.60). After multivariable negative binomial regression adjusting for confounders including operation type, the difference remained non-significant, with an adjusted incidence rate ratio (IRR) for LOS of 0.94 (95% CI 0.84–1.04; p = 0.20).

"Following bariatric surgery, there was no significant difference in LOS between EP and LEP patients (2.26 days vs. 2.12 days respectively; p = 0.60). Multivariable negative binomial regression was used to adjust for confounders of LOS listed above, including operation type, resulting in an adjusted incidence rate ratio (IRR) for LOS of 0.94 (95% CI 0.84–1.04; p = 0.20)." (Stolarski, 2022, p. 7386)

Methods Context #

What? #ⓘ

The observable: length of stay (LOS) in days from the index bariatric operation, abstracted from the electronic medical record and compared between LEP and EP patients.

"Outcomes of interest included 30-day and one year all cause visits to the emergency department (ED), 30-day and one year readmission, length of stay (LOS) from index operation, chief-complaint on readmission, as well as post-operative complications" (Stolarski, 2022, p. 7386)

How? #ⓘ

Retrospective chart review using the institution's MBSAQIP database; LOS compared with univariate tests and adjusted using multivariable negative binomial regression with a priori confounders (age, sex, race, insurance status, ASA class, smoking status, year of operation, and sleeve gastrectomy).

"We performed a retrospective review of all patients who underwent bariatric surgery from January 2013 to December 2017 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for our institution, an academic medical center with substantial patient diversity." (Stolarski, 2022, p. 7386)

Who? #ⓘ

1662 patients aged 18+ who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass from Jan 2013–Dec 2017 at one high-volume academic bariatric center (Boston Medical Center); 671 (40%) classified as LEP, speaking six languages (top: Portuguese, Spanish).

"Over the 5-year study period, 1662 patients underwent SG or LGBP at our bariatric center (Fig. 1). 671 patients were categorized as LEP (40%) (Table 1)." (Stolarski, 2022, p. 7386)

Other Notes #

LOS was classified by the authors as the exposure being LEP (identified via interpreter use / documented non-English preferred language). The point estimate (IRR 0.94) is close to the null with a CI spanning 1.0; the authors frame this as equivalence rather than a measured difference.

Caveats #

• Single high-volume center with substantial interpreter infrastructure limits generalizability of equivalent bariatric outcomes The equivalent outcomes were observed at a single, high-volume academic center with substantial interpreter infrastructure (nearly 1.4 million interpreter requests over five years, in-person interpreters in 13+ languages, 24-hour voice/video access, multilingual surgeons, and educational/discharge materials printed in English, Spanish, and Portuguese). The authors caution that the findings may not transfer to institutions with fewer such resources, so the null/equivalence results cannot be read as evidence that LEP carries no risk in lower-resourced settings.