Interpreter use was not associated with incidence of any complication (OR 1.105, P=0.60) after breast reduction

Description #

In a multivariable logistic regression predicting the presence of any postoperative complication within 3 months, interpreter use (the proxy for LEP status) was not significantly associated with complication incidence: odds ratio 1.105 (95% CI 0.759–1.607, P = 0.60; Table 4). The CI comfortably includes 1.0, so this adjusted null opposes the claim that LEP raises postoperative complication odds. In the same model, BMI (OR 1.080 per unit, 95% CI 1.046–1.115, P < 0.001) and diabetes (OR 2.227, 95% CI 1.217–4.077, P = 0.01) were the significant drivers of complications instead.

"LEP status was not significantly associated with the incidence of having any complications postoperatively (Table 4)." (Fei, 2024, p. 691)

Methods Context #

What? #ⓘ

The observable: presence of any postoperative complication within 3 months (the binary composite "any complication").

"All complications were collated to form the composite 'any complication' in which 'yes' would indicate the presence of any aforementioned complications." (Fei, 2024, p. 690)

How? #ⓘ

Multivariable logistic regression built with a backwards model-building approach, regressing interpreter use, age, BMI, and diabetes on the presence of any complication.

"In addition, a backwards model building approach was utilized for a multivariable logistic regression model used to determine the association between LEP status and incidence of any complications adjusting for potential confounders such as age, BMI, and comorbidities." (Fei, 2024, p. 691)

Who? #ⓘ

All 1023 breast-reduction patients in the analytic cohort (single urban academic center, 2015–2019).

"Table 4 details the result of a multivariable logistic regression in which covariates are regressed on the presence of any complications within 3 mo. N = 1023." (Fei, 2024, p. 691)

Other Notes #

Interpreter use served as the proxy for LEP status (see qualifying caveat). Note an internal inconsistency in the diabetes odds ratio: the abstract reports OR 2.234 while Table 4 reports OR 2.227 for diabetes; both are quoted where cited. This does not affect the LEP/interpreter null.

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."