From the Department of Anesthesiology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois.
Anesth Analg. 2023 Jun 1;136(6):1096-1106. doi: 10.1213/ANE.0000000000006159. Epub 2022 Sep 6.
This systematic review assesses whether limited-English proficiency (LEP) increases risk of having poor perioperative care and outcomes. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 99 articles were identified in Embase and PubMed and screened by 2 independent reviewers. Ten studies, which included 3 prospective cohort studies, 6 retrospective cohort studies, and 1 cross-sectional study, met inclusion and exclusion criteria. All studies were of high-quality rating according to the Newcastle-Ottawa scale. Subsequently, the Levels of Evidence Rating Scale for Prognostic/Risk Studies and Grade Practice Recommendations from the American Society of Plastic Surgeons were used to assess the quality of evidence of each study and the strength of the body of evidence, respectively. There is strong evidence that professional medical interpreter (PMI) use or having a language-concordant provider for LEP patients improves understanding of the procedural consent. The evidence also highly suggests that LEP patients are at risk of poorer postoperative pain control and poorer understanding of discharge instructions compared with English-speaking patients. Further studies are needed to discern whether consistent PMI use can minimize the disparities in pain control and discharge planning between LEP and English-proficient (EP) patients. There is some evidence that LEP status is not associated with differences in having adequate access to and receiving surgical preoperative evaluation. However, the evidence is weak given the small number of studies available. There are currently no studies on whether LEP status impacts access to preoperative evaluation by an anesthesiology-led team to optimize the patient for surgery. There is some evidence to suggest that LEP patients, especially when PMI services are not used consistently, are at risk for increased length of stay, more complications, and worse clinical outcomes. The available outcomes research is limited by the relative infrequency of complications. Additionally, only 4 studies validated whether LEP patients utilized a PMI. Future studies should use larger sample sizes and ascertain whether LEP patients utilized a PMI, and the effect of PMI use on outcomes.
本系统评价评估了有限英语水平（LEP）是否会增加围手术期护理和结局不良的风险。本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。在 Embase 和 PubMed 中总共确定了 99 篇文章，并由 2 名独立审查员进行筛选。10 项研究符合纳入和排除标准，其中包括 3 项前瞻性队列研究、6 项回顾性队列研究和 1 项横断面研究。根据纽卡斯尔-渥太华量表，所有研究均为高质量评分。随后，使用预后/风险研究的证据水平评级量表和美国整形外科学会的实践推荐等级来评估每项研究的证据质量和证据体的强度。有强有力的证据表明，专业医疗口译员（PMI）的使用或为 LEP 患者提供语言一致的提供者可以提高对手术同意书的理解。证据还强烈表明，与讲英语的患者相比，LEP 患者术后疼痛控制较差，对出院指示的理解较差。需要进一步研究以确定是否持续使用 PMI 可以最大限度地减少 LEP 和英语熟练（EP）患者在疼痛控制和出院计划方面的差异。有一些证据表明，LEP 状态与获得和接受手术术前评估的机会没有差异。然而，由于可用的研究数量较少，证据较弱。目前尚无研究表明 LEP 状态是否会影响麻醉科主导团队进行术前评估以优化患者手术的机会。有一些证据表明，LEP 患者，尤其是当未持续使用 PMI 服务时，存在住院时间延长、并发症增多和临床结局恶化的风险。可用的结局研究受到并发症相对罕见的限制。此外，只有 4 项研究验证了 LEP 患者是否使用了 PMI。未来的研究应使用更大的样本量，并确定 LEP 患者是否使用了 PMI，以及 PMI 使用对结局的影响。
