NES patients had higher readmission rates than ES (4.43% vs 0.96%) after spine surgery

Description #

In the matched cohort (158 non-English speakers [NES] vs 313 English speakers [ES]) undergoing spine surgery, the readmission rate was significantly higher for the NES group than the ES group (4.43% vs 0.96%; P = 0.033; Table 3). This univariate difference was one of only two outcome measures (with number of postoperative visits) that reached significance after matching.

"The rate of intraoperative complications was similar (1.6% vs 3.8%, P = 0.242), while readmission (0.96% vs 4.43%, P = 0.033) was significantly higher for the NES group." (Tejas, 2025, p. E557)

"NES patients had significantly more postoperative visits (2.19 vs 1.73; P < 0.001) and increased readmission rates (0.96% vs 4.43%; P = 0.033)." (Tejas, 2025, p. E556)

Methods Context #

What? #ⓘ

The observable: hospital readmission (rate), abstracted as an outcome measure from the institution's electronic health record.

"Outcome measures, including length of stay, any intraoperative or postoperative surgical or medical complications, discharge disposition, readmission, and reoperation, were collected." (Tejas, 2025, p. E557)

How? #ⓘ

Retrospective cohort with a 1:2 "greedy" nearest-neighbor match of NES to ES on surgical procedure, age, sex, race, BMI, smoking, preoperative opioid use, ASA class, insurance type, and CCI; categorical outcomes such as readmission compared with a χ2 or Fisher exact test.

"NES patients were then matched in a 1:2 "greedy" nearest neighbor match with ES to control for demographic, comorbidity, and operative differences between the two groups." (Tejas, 2025, p. E557)

Who? #ⓘ

The matched cohort of 158 NES and 313 ES patients (drawn from 214 NES and 9217 ES reviewed), aged ≥18, operated on by 8 orthopedic spine surgeons at a single large academic hospital (Hospital for Special Surgery, New York) between 2017 and 2023.

"After matching, 158 NES patients and 313 ES patients. No significant difference existed between any demographic factors analyzed, indicating appropriate matching (Table 2)." (Tejas, 2025, p. E557)

Other Notes #

The readmission timeframe (e.g., 30-day) is not specified in the paper; Table 3 reports readmission only as a percentage.

Caveats #

• Single academic institution limits generalizability of the NES spine-surgery outcomes The study was conducted at a single large academic institution (Hospital for Special Surgery, New York). The authors caution that their NES population may not represent NES spine-surgery patients across the United States, whose demographics vary substantially by geography. A majority of NES patients were coded as "other" race in the EMR, so residual baseline differences may persist despite matching. Findings therefore may not generalize to other settings, payer mixes, or language populations.
• Readmission findings rest on very low event counts, yielding an imprecise effect estimate The readmission findings rest on very few events. With readmission rates of 0.96% among 313 ES (≈3 patients) and 4.43% among 158 NES (≈7 patients), both the univariate significance test and the multivariable odds ratio are driven by roughly a dozen readmissions across the whole cohort. This is reflected in the wide 95% confidence interval for the multivariable estimate (OR 4.22, 95% CI 1.63–10.94), which signals substantial imprecision. The authors separately acknowledge that the overall NES sample was small.
• Translator usage in the EMR was a binary proxy for limited English proficiency, not a validated LEP measure The exposure (non-English speaker / limited English proficiency) was defined solely by whether the electronic medical record contained a binary "yes/no" flag for translator usage, used as a proxy for poor English proficiency. This is not a validated measure of language proficiency: patients who needed but were not flagged for a translator, or who were flagged but were reasonably proficient, could be misclassified. It also captures documented translator need rather than whether an interpreter was actually used throughout each encounter — the authors note interpreter services are not always used at every interaction — so the NES/ES contrast may misclassify true language discordance and its downstream care.
• Retrospective heterogeneous-cohort design leaves residual confounding in the NES spine-surgery outcomes This is a retrospective EMR chart review, so despite 1:2 matching and multivariable adjustment, unmeasured confounding and data-quality limitations remain. Because the small NES cohort prevented per-procedure analysis, matching was done across many different spine procedures, producing intrinsically heterogeneous comparison groups. The NES cohort was also heterogeneous in the specific languages spoken, plausibly varying the translators and translation quality across patients and introducing additional bias into the measured outcomes.