LEP and EP patients had similar rates of surgical site infection, sepsis, and encephalopathy after knee arthroplasty

Description #

There were no statistically significant differences between limited-English-proficiency (LEP) and English-proficient (EP) patients in rates of 90-day surgical site infection, 7-day sepsis, or 1-day encephalopathy after elective total knee arthroplasty (Figure 1). For surgical site infection the direction actually favoured EP patients (LEP 2.9% vs EP 3.6%), and the covariate-adjusted odds ratio was 0.84 (95% CI 0.42–1.69), consistent with no association (Figure 2).

"There were no significant differences in rates of 90‐day surgical sites infections, 7‐day sepsis, 1‐day encephalopathy or in rates of arthroplasty specific complications (Figure 1)." (Nguyen, 2023, p. 577)

"90-day Surgical Site Infection 0.84 (0.42,1.69)" (Nguyen, 2023, Fig. 2, p. 579)

Methods Context #

What? #ⓘ

The observable: rates of 90-day surgical site infection, 7-day sepsis, and 1-day encephalopathy — CMS-defined general postoperative complications.

"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 (with a multivariable logistic model additionally estimating the adjusted odds ratio for surgical site infection).

"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.

"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 #

Figure 1 individual rates (LEP vs EP): 90-day surgical site infection 2.9% vs 3.6% (p = 0.6); 7-day sepsis 0.3% vs 0.2% (p = 0.5); 1-day encephalopathy 0.3% vs 0.1% (p = 0.4). These nulls bound the LEP–complication association to thromboembolic (and crude pneumonia) events rather than all postoperative complications.