LEP patients had longer length of hospital stay than EP (2.8 vs 2.3 days) after knee arthroplasty

Description #

Patients with limited English proficiency (LEP) had a longer mean length of hospital stay than English-proficient (EP) patients after elective total knee arthroplasty: 2.8 ± 2.1 days vs 2.3 ± 1.7 days (p < 0.001) (Table 1).

"Patients with LEP had longer lengths of hospitalisation (mean: 2.8 ± 2.1 days vs. 2.3 ± 1.7 days, p < 0.001) (Table 1)." (Nguyen, 2023, p. 577)

Methods Context #

What? #ⓘ

The observable: length of hospital stay in days, a perioperative metric obtained from the electronic health record.

"Demographic and perioperative data were obtained from patients' electronic health records." (Nguyen, 2023, p. 577)

How? #ⓘ

Two-sample t-test comparing the continuous length-of-stay variable between LEP and EP groups.

"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), 9.2% (316) with LEP.

"This was a retrospective cohort study of elective TKA patients ≥18 years of age between January 2013 and December 2021 from a single academic medical centre serving an ethnically and linguistically diverse urban centre." (Nguyen, 2023, p. 576)

Other Notes #

Length of stay was also entered as a covariate in the complication-outcome regression models, so the adjusted complication odds ratios are estimated net of this LOS difference.

Caveats #

• 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.