LEP status did not differ between low and high postoperative follow-up groups (20.0% vs 22.4%, P=0.35) after breast reduction

Description #

When patients were split into low (≤3 postoperative office visits) and high (>3 visits) follow-up cohorts, the proportion who were LEP did not differ significantly between the two groups: 20.0% (118/590) in the low follow-up group versus 22.4% (97/433) in the high follow-up group (P = 0.35; Table 2). This is a null result and opposes the claim that LEP is associated with greater postoperative follow-up utilization — LEP patients were not over-represented among high-follow-up patients. By contrast, in the same table older age, private insurance, diabetes, and complications did differ significantly between the follow-up cohorts.

"There were no significant differences in race/ethnicity, smoking status, and LEP status (20% & 22.4% in the low and high follow-up groups, respectively) as proxied by interpreter use between groups." (Fei, 2024, p. 691)

Methods Context #

What? #ⓘ

The observable: follow-up-cohort membership, defined by the number of postoperative office visits (low ≤3 vs high >3, the median in the overall cohort).

"Patients who had three or fewer clinic visits were assigned to the low follow-up group and patients with greater than three clinic visits were assigned to the high follow-up group." (Fei, 2024, p. 691)

How? #ⓘ

Bivariate between-cohort comparison of the LEP proportion (proxied by interpreter use) across the low- and high-follow-up groups, using Chi-square / Fisher's exact test (P = 0.35 reported in Table 2).

"Chi-square analysis with Fisher's exact test were used to perform between cohort comparisons of patient characteristics, comorbidities, perioperative and postoperative statistics." (Fei, 2024, p. 691)

Who? #ⓘ

590 low-follow-up and 433 high-follow-up breast-reduction patients (total 1023) at a single urban academic center, 2015–2019.

"In total, there were 590 (57.7%) individuals in the low follow-up group and 433 (42.3%) in the high follow-up group." (Fei, 2024, p. 691)

Other Notes #

Table 2 reports the LEP row as 118 (20.0%) vs 97 (22.4%), P = 0.35. LEP status was proxied by documented interpreter use (see qualifying caveat).

Caveats #

• LEP status was proxied by documented interpreter use and non-English consent forms, not directly measured (Wang 2024) The exposure of interest, LEP status, was never measured directly. It was operationalized as a proxy — patients who had documented interpreter use and/or required non-English consent forms in the chart were classified as LEP. Because all LEP patients in the cohort used interpreters, the study cannot separate the effect of language discordance from the effect of receiving interpreting services, and any LEP patients who did not have interpreter use or non-English consent documented would be misclassified as non-LEP. [Inferred: non-differential misclassification of the exposure of this kind tends to bias effect estimates toward the null, so the reported null associations may partly reflect exposure measurement error rather than a true absence of effect.]
• Retrospective single-center BRM cohort, predominantly Spanish-speaking and possibly underpowered to detect a small LEP association (Wang 2024) The null LEP associations come from a retrospective, observational, single-institution cohort — not a randomized trial — so measured and unmeasured confounders could not be fully controlled despite multivariable adjustment. The authors explicitly note the sample may be inadequate to detect a small but genuine LEP effect, which is the central threat to interpreting these nulls as true absence of effect. The cohort was also predominantly Spanish-speaking, precluding stratification by language, and drawn from a single urban academic center with an LEP rate nearly double the U.S. average, limiting generalizability (especially to rural settings and non-Spanish LEP groups). Together these features make the null findings hypothesis-consistent but not confirmatory of "no effect."