Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2022 Dec;29(13):8610-8618. doi: 10.1245/s10434-022-12354-x. Epub 2022 Aug 6.
Preoperative decision-making in patients who speak a primary language other than English is understudied. We investigated whether patient primary language is associated with differences in immediate breast reconstruction (IBR) after mastectomy.
This retrospective observational study analyzed female patients undergoing mastectomy in the New Jersey State Inpatient Database (2009-2014). The primary outcome was the odds of IBR with a prespecified subanalysis of autologous tissue-based IBR. We used multivariable logistic regression and hierarchical generalized linear mixed models to control for patient characteristics and nesting within hospitals.
Of 13,846 discharges, 12,924 (93.3%) specified English as the patient's primary language, while 922 (6.7%) specified a language other than English. Among English-speaking patients, 6178 (47.8%) underwent IBR, including 2310 (17.9%) autologous reconstructions. Among patients with a primary language other than English, 339 (36.8%) underwent IBR, including 93 (10.1%) autologous reconstructions. Unadjusted results showed reduced odds of IBR overall [odds ratio (OR) 0.64, 95% CI 0.55-0.73], and autologous reconstruction specifically (OR 0.52, 95% CI 0.41-0.64) among patients with a primary language other than English. After adjustment for patient factors, this difference persisted among the autologous subgroup (OR 0.64, 95% CI 0.51-0.80) but not for IBR overall. A hierarchical model incorporating both patient characteristics and hospital-level effects continued to show a difference among the autologous subgroup (OR 0.75, 95% CI 0.58-0.97).
Primary language other than English was an independent risk factor for lower odds of autologous IBR after adjustments for patient and hospital effects. Focused efforts should be made to ensure that patients who speak a primary language other than English have access to high-quality shared decision-making for postmastectomy IBR.
对于母语非英语的患者，术前决策研究较少。本研究旨在探讨患者母语是否与乳房切除术后即刻乳房重建（IBR）的差异相关。
本回顾性观察性研究分析了 2009 年至 2014 年新泽西州住院患者数据库中接受乳房切除术的女性患者。主要结局为 IBR 的比值比（OR），并进行了自体组织为基础的 IBR 的预设亚分析。采用多变量逻辑回归和分层广义线性混合模型来控制患者特征和医院内嵌套。
在 13846 例出院患者中，12924 例（93.3%）报告英语为患者的主要语言，922 例（6.7%）报告其他语言。在讲英语的患者中，6178 例（47.8%）接受了 IBR，其中 2310 例（17.9%）为自体重建。在母语非英语的患者中，339 例（36.8%）接受了 IBR，其中 93 例（10.1%）为自体重建。未调整结果显示，母语非英语患者的 IBR 总体[OR（比值比）0.64，95%可信区间（CI）0.55-0.73]和自体重建[OR（比值比）0.52，95% CI 0.41-0.64]的几率均降低。在调整患者因素后，这种差异在自体亚组中仍然存在（OR 0.64，95% CI 0.51-0.80），但在 IBR 总体中没有。纳入患者特征和医院水平影响的分层模型仍显示，自体亚组中存在差异（OR 0.75，95% CI 0.58-0.97）。
在调整患者和医院效果后，母语非英语是自体 IBR 几率降低的独立危险因素。应重点努力确保母语非英语的患者能够获得高质量的乳房切除术后 IBR 共享决策。
