LEP patients had higher unadjusted 30-day DVT rates than EP (2.5% vs 0.8%) after knee arthroplasty

Description #

On unadjusted comparison (Fisher's exact test), patients with limited English proficiency (LEP) had a higher rate of 30-day postoperative deep vein thrombosis (DVT) than English-proficient (EP) patients after elective total knee arthroplasty: 2.5% vs 0.8% (p = 0.01) (Figure 1).

"When comparing rates of postoperative complications between LEP and EP patients, LEP patients had higher rates of 30‐day DVT (2.5% vs. 0.8%, p = 0.01), 30‐day VTE (3.8% vs. 1.9%, p = 0.03), and 7‐day pneumonia (1.3% vs. 0.3%, p = 0.02)." (Nguyen, 2023, p. 577)

Methods Context #

What? #ⓘ

The observable: rate of 30-day postoperative deep vein thrombosis, one of the CMS-defined postoperative complications ascertained from the electronic health record.

"Complications analysed included 30‐day deep vein thrombosis (DVT), 30‐day venous thromboembolism (VTE), 90‐day surgical site infection, 7‐day pneumonia, 7‐day sepsis, and 1‐day encephalopathy." (Nguyen, 2023, p. 577)

How? #ⓘ

Unadjusted between-group comparison of categorical complication rates using Fisher's exact test.

"Comparisons of baseline characteristics, perioperative metrics, and postoperative complication rates between EP and LEP patients were performed using t‐test for continuous variables and Fisher's exact test for categorical variables." (Nguyen, 2023, p. 577)

Who? #ⓘ

3450 elective TKA cases at a single academic medical centre (2013–2021), of whom 9.2% (316) had LEP; LEP defined as self-reporting a primary language other than English.

"A total of 3450 TKA cases were performed between January 2013 and December 2021. 9.2% (316) of the patients were classified as having LEP." (Nguyen, 2023, p. 577)

Other Notes #

This is the unadjusted (crude) rate difference; the corresponding covariate-adjusted estimate (aOR 2.84) is captured in a separate EVD.

Caveats #

• All LEP patients grouped despite heterogeneity in language, provider capacity, and English proficiency level All patients with limited English proficiency were analysed as a single group, defined only by self-reporting a primary language other than English. This collapses substantial heterogeneity: the degree of patients' actual English proficiency varies, and nursing and provider language-concordance capacity differs across languages (e.g., Spanish vs Chinese vs Russian). Pooling these subgroups may dilute or distort the association between language discordance and complications, and prevents the study from identifying which patients face the greatest risk.
• Single-center retrospective EHR cohort cannot identify mediators or confounders of LEP-associated complications The study is a retrospective cohort drawn from a single academic medical centre, and the authors note two consequences. First, although the electronic health record is a reliable source for complication counts, the design cannot identify the specific mediators or clinical confounders that drive the LEP–complication association, so the results are correlational rather than mechanistic. Second, single-site data limit external validity; the authors call for multi-site replication, while noting that larger national databases lack primary-language data. These features mean the effect estimates may not generalise and cannot establish causal pathways.