Interpreter modality (in-person, phone, video) was not associated with regional anesthesia utilization for total joint arthroplasty

Description #

Among patients who used an interpreter, the modality of interpretation (in-person, telephone, or video) was not significantly associated with regional anesthesia utilization (Table; "Interpreter modality" P = .5026). In-person interpreting dominated: of the RA patients who used an interpreter, 74.9% were in person, 14.5% telephone, 9.8% video, and 0.8% unspecified; all 10 non-RA interpreter users were in person. This directly addresses the paper's stated open question of whether translation modality influences RA utilization, and answers it in the null.

"It is also unknown whether translation modality influences RA utilization." (Sabra, 2025, p. 993)

"Interpreter modality (among interpreter used = yes) … Person … 10 … 100.0 … 734 … 74.9 … Phone … 0 … 0.0 … 142 … 14.5 … Video … 0 … 0.0 … 96 … 9.8 … Unspecified … 0 … 0.0 … 8 … 0.8 … .5026" (Sabra, 2025, p. 994, Table)

Methods Context #

What? #ⓘ

The observable: regional anesthesia utilization compared across the modality of interpretation (in-person, video, telephone) among interpreter-using patients.

"Additional variables included … translation modality (in-person, video, or telephone translation) as documented on the EMR." (Sabra, 2025, p. 993)

How? #ⓘ

Univariate χ² association between documented interpreter modality and RA use, restricted to the interpreter-using subgroup, from the EMR search of THR/TKR patients 2016–2023.

"Univariate associations between RA use and all available variables … were assessed using Mann-Whitney U tests and χ² tests." (Sabra, 2025, p. 993)

Who? #ⓘ

The subgroup of ~990 THR/TKR patients at HSS (2016–2023) with a documented interpreter, out of the full cohort of 58,918.

"Interpreter modality (among interpreter used = yes)" (Sabra, 2025, p. 994, Table)

Other Notes #

Table-only association. The interpreter-using subgroup is tiny (~990 total; only 10 in the non-RA arm, all in-person), giving minimal power to detect any modality effect.

Caveats #

• Retrospective single-institution EMR study with provider-bias variability and unmeasured cognitive impairment The findings come from a single-institution, retrospective EMR-based study at one specialized orthopedic hospital (HSS), which limits generalizability to centers with different patient populations, payer mixes, and RA practices. The authors also note variability in provider bias, and that they could not exclude patients with cognitive impairment because that variable was unavailable in the record — a potential uncontrolled confounder of both language documentation and anesthetic decision-making. Interpreter use and modality were captured only as documented in the EMR, which may undercount actual language-service use.
• Underpowered to detect the small observed language effect despite large sample (post hoc power) Despite the large overall sample (58,918 patients), the study is by the authors' own post hoc assessment underpowered to detect the small, non-significant language effect it observed. The design targets clinically meaningful differences of ≥2%; a true difference smaller than that (or concentrated in the tiny LEP subgroup) could be overlooked. This is the central interpretive caveat on all of the null language findings: absence of a detected association is not evidence of no association. The authors caution the results should be interpreted cautiously and note that post hoc power calculations are not recommended for definitive conclusions.