LEP was not associated with 30-day readmission (adjusted OR 0.80, 95% CI 0.49-1.28) after total joint arthroplasty

Description #

In this retrospective cohort of 4721 total joint arthroplasty (TJA) patients, 30-day hospital readmission rates did not differ by language status on univariate analysis (LEP 30 of 378 [7.9%] vs English proficient 312 of 4343 [7.2%]; P = .59). This null result held in the adjusted logistic model: LEP was not associated with 30-day readmission (odds ratio, 0.80; 95% CI, 0.49-1.28; P = .35) — the confidence interval spans 1, and the point estimate is below 1 (Table 2). This is the one outcome of four with no significant LEP association.

"There was no difference in 30-day readmission rates by language status (Table 2)." (Manuel, 2022, p. 3)

"LEP was associated with ... but not with 30-day readmission (odds ratio, 0.80; 95% CI, 0.49-1.28) (Table 2)." (Manuel, 2022, p. 3)

"30-d Readmission, patients, No. (%) 342 (7.2) 312 (7.2) 30 (7.9) .59" (Manuel, 2022, Table 2, p. 2)

Methods Context #

What? #ⓘ

The observable: rate of 30-day hospital readmission.

"we examine the association of LEP with ... rate of 30-day readmission after TJA." (Manuel, 2022, p. 1)

How? #ⓘ

Binomial logistic regression adjusting for a pre-specified covariate set (demographics, insurance, ASA status, case class, case length, blood loss); reference group is English-proficient patients.

"Binomial logistic regressions were used to understand the association of LEP with discharge disposition and 30-day readmission rates." (Manuel, 2022, p. 1)

Who? #ⓘ

Patients aged 18 years or older who underwent TJA from 2015 to 2019 at a single urban academic medical center (N = 4721; 4343 English proficient, 378 LEP). Only 30 readmission events occurred in the LEP group, yielding an imprecise estimate.

"This study used electronic health data of patients aged 18 years or older who underwent TJA from 2015 to 2019 at an urban academic medical center" (Manuel, 2022, p. 1)

Other Notes #

This is a null / non-significant finding and therefore opposes the claim that LEP raises post-arthroplasty readmission. The wide 95% CI (0.49-1.28) and small number of LEP readmission events (n = 30) mean the study is likely underpowered to detect a readmission difference; the null should not be read as evidence of no effect (see qualifying caveat).

Caveats #

• Observational single-center EHR-derived cohort with LEP defined by interpreter request; residual confounding precludes causal inference The findings are from a retrospective observational cohort at a single urban academic medical center, using variables derived from the electronic health record, and can establish association but not causation. The authors explicitly acknowledge the limitations inherent to observational EHR-based analysis (with further detail deferred to an unavailable eAppendix). Residual and unmeasured confounding is possible despite multivariable adjustment; the exposure (LEP) was operationalized as a non-English language preference plus a recorded request for interpreter services, which may misclassify patients who are LEP but did not request an interpreter, and single-center results may not generalize to other settings or payer/case mixes.
• Small LEP subgroup with only 30 readmission events leaves the null readmission result underpowered and imprecise [Inferred:] The null 30-day readmission result rests on a small LEP subgroup (n = 378) with only 30 readmission events, and the adjusted odds ratio has a wide confidence interval (0.80; 95% CI, 0.49-1.28) that spans no effect. The study is therefore likely underpowered to detect a readmission difference, and the non-significant result should be read as inconclusive rather than as evidence that LEP has no effect on readmission. (The authors did not report a power analysis for this outcome; this is an inference from the reported event counts and interval width.)