Department of Surgery, Boston Medical Center, Boston Massachusetts; Division of Acute Care and Trauma Surgery, Boston Medical Center, Boston Massachusetts.
Department of Surgery, Boston Medical Center, Boston Massachusetts; Division of Acute Care and Trauma Surgery, Boston Medical Center, Boston Massachusetts.
J Surg Res. 2019 Dec;244:484-491. doi: 10.1016/j.jss.2019.06.082. Epub 2019 Jul 19.
Emergency general surgery (EGS) represents a diverse set of operations performed on acutely ill patients. Those undergoing EGS are at higher likelihood of complications, readmission, and death, but the effect of primary language on EGS outcomes has not been evaluated. We aimed to evaluate the association of non-English primary language on outcomes after EGS operations.
The New Jersey Statewide Inpatient Database from 2009 to 2014 was used to evaluate cases representing 80% of the national burden of EGS. Cases were restricted to ages ≥18 y, emergency department admissions, noted to be emergent or urgent, and performed between 0 and 2 d after admission. We evaluated Spanish speakers and non-English, non-Spanish (NENS) speakers compared with English. Outcomes included in-hospital mortality, 7-d readmission, and hospital length of stay (LOS). Logistic and negative binomial regression was used, and generalized linear mixed models were used to account for hierarchy in the data.
There were 105,171 patients included. English speakers were majority white and with private insurance; Spanish speakers were younger and with fewer comorbidities. Where differences between Spanish and NENS speakers existed, NENS were more like the English-speaking group. Adjusted results indicate that Spanish speakers had reduced LOS after appendectomy (IRR: 0.92 [0.89-0.95]) and lysis of adhesion [0.93 (0.88-0.97)]. Spanish speakers had an increased LOS after higher risk operations (IRR: 1.14 [1.10-1.20]). NENS speakers had a reduced LOS after adhesiolysis (IRR: 0.94 [0.89-0.99]). There was no difference in mortality or short-term readmission CONCLUSIONS: These data from a large database suggest that the effect of primary language on LOS after EGS depends on the type of operation. Future studies should focus on long-term outcomes and determining if the lack of association we observed is generalizable to other regions of the United States.
急诊普通外科（EGS）代表了对急性病患者进行的一系列多样化手术。接受 EGS 的患者发生并发症、再入院和死亡的可能性更高，但主要语言对 EGS 结果的影响尚未得到评估。我们旨在评估非英语主要语言对 EGS 手术后结果的影响。
使用 2009 年至 2014 年新泽西州全州住院患者数据库评估了代表 80%EGS 全国负担的病例。病例限于年龄≥18 岁、急诊科入院、被认为是紧急或紧急的患者，并在入院后 0 至 2 天内进行。我们评估了西班牙语患者和非英语、非西班牙语（NENS）患者与英语患者的比较。结果包括院内死亡率、7 天再入院率和住院时间（LOS）。使用逻辑回归和负二项回归，并使用广义线性混合模型来解释数据中的层次结构。
共有 105171 例患者入选。英语患者主要为白人且拥有私人保险；西班牙语患者更年轻，合并症较少。西班牙语患者和 NENS 患者之间存在差异，NENS 患者更像英语患者。调整后的结果表明，西班牙语患者阑尾切除术（IRR：0.92[0.89-0.95]）和粘连松解术（IRR：0.93[0.88-0.97]）后的 LOS 缩短。西班牙语患者风险较高的手术（IRR：1.14[1.10-1.20]）后的 LOS 增加。粘连松解术（IRR：0.94[0.89-0.99]）后 NENS 患者的 LOS 缩短。死亡率或短期再入院率无差异。
来自大型数据库的这些数据表明，主要语言对 EGS 手术后 LOS 的影响取决于手术类型。未来的研究应关注长期结果，并确定我们观察到的缺乏关联是否可推广到美国其他地区。
