Interpreter use was the strongest predictor of LOS after TSA, adding 0.88 days per patient

Description #

In a matched retrospective cohort of total shoulder arthroplasty (TSA) patients, mean hospital length of stay (LOS) was longer in the cohort that required a language interpreter than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, P = .048). On multivariate linear regression controlling for age, BMI, sex, smoking, opioid use, race, insurance, procedure, and diagnosis, interpreter use was the strongest predictor of LOS, with an effect estimate of an additional 0.88 days per patient (β = 0.88, 95% CI 0.28–1.81, P = .008) (Table 2).

"Patients in the interpreter cohort had significantly longer hospital LOS on average compared with those in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, P = .048)." (Kunze, 2023, p. 87)

"Multivariate linear regression analysis demonstrated that the need for an interpreter was the strongest predictor of hospital LOS, with the effect estimate indicating an additional 0.88-day LOS per patient compared with patients who did not need a language interpreter (Table 2)." (Kunze, 2023, p. 87)

Methods Context #

What? #ⓘ

The observable: hospital length of stay until discharge after TSA, measured in days, as the primary outcome.

"The primary outcome of interest was LOS until discharge after TSA measured in days." (Kunze, 2023, p. 86)

How? #ⓘ

Single-institution retrospective cohort study; interpreter and non-interpreter cohorts matched 1:1 on age, BMI, sex, and procedure, with multivariate linear regression controlling for additional confounders.

"We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure." (Kunze, 2023, p. 85)

Who? #ⓘ

41 interpreter-requiring TSA patients matched to 41 non-interpreter patients at a single urban institution (Hospital for Special Surgery, NY), from a TSA registry querying consecutive reverse/anatomic TSA cases January 2016–March 2020; interpreter languages included Spanish, Arabic, Cantonese, Russian, Italian, Greek, and Polish.

"A total of 41 patients who underwent TSA and required the use of a language interpreter (interpreter cohort) were identified. A total of 41 patients who did not required the use of a language interpreter (non-interpreter cohort) and underwent TSA during the same period were matched by age, BMI, sex, and procedure." (Kunze, 2023, p. 87)

Other Notes #

Interpreter services at this institution were provided free of charge by licensed experts via on-site in-person, videoconferencing, or telephone interpretation; the authors interpret the persistent LOS disparity as evidence that differences in outcomes persist despite access to interpreter resources.

Caveats #

• Retrospective TSA cohort could not control for unmeasured confounders (OSA, surgeon LOS thresholds, social factors) affecting LOS and discharge Because the study was a retrospective chart review, several factors plausibly affecting length of stay and discharge disposition could not be measured or controlled, even though cohorts were matched on age, BMI, sex, and procedure. The authors specifically name obstructive sleep apnea (which has LOS implications and was unavailable), surgeon-specific differences in postoperative LOS thresholds and protocols (introduced by pooling a 12-surgeon registry, neither quantified nor studied), day of the week of surgery, and unrecorded social factors (a patient's cultural expectations of hospital stay and home situation affecting safe discharge). These residual confounders mean the observed interpreter–LOS and interpreter–disposition associations may be partly attributable to factors other than the language barrier itself.