LEP patients had higher unadjusted 7-day pneumonia rates than EP (1.3% vs 0.3%) after knee arthroplasty

Description #

On unadjusted comparison (Fisher's exact test), patients with limited English proficiency (LEP) had a higher rate of 7-day postoperative pneumonia than English-proficient (EP) patients after elective total knee arthroplasty: 1.3% vs 0.3% (p = 0.02) (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 7-day postoperative pneumonia, a CMS-defined postoperative complication 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), 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 #

This unadjusted difference did not persist after covariate adjustment (aOR 2.77, 95% CI 0.57–13.51), captured in a separate EVD; the two findings together show a language–pneumonia association that is significant crude but non-significant adjusted.

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.