Harvard Medical School, Boston, Massachusetts.
Massachusetts General Hospital, Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Boston, Massachusetts.
West J Emerg Med. 2023 Feb 1;24(2):141-148. doi: 10.5811/westjem.2022.10.57276.
English proficiency and race are both independently known to affect surgical access and quality, but relatively little is known about the impact of race and limited English proficiency (LEP) on admission for emergency surgery from the emergency department (ED). Our objective was to examine the influence of race and English proficiency on admission for emergency surgery from the ED.
We conducted a retrospective observational cohort study from January 1-December 31, 2019 at a large, quaternary-care urban, academic medical center with a 66-bed ED Level I trauma and burn center. We included ED patients of all self-reported races reporting a preferred language other than English and requiring an interpreter or declaring English as their preferred language (control group). A multivariable logistic regression was fit to assess the association of LEP status, race, age, gender, method of arrival to the ED, insurance status, and the interaction between LEP status and race with admission for surgery from the ED.
A total of 85,899 patients (48.1% female) were included in this analysis, of whom 3,179 (3.7%) were admitted for emergent surgery. Regardless of LEP status, patients identifying as Black (odds ratio [OR] 0.456, 95% CI 0.388-0.533; P<0.005), Asian [OR 0.759, 95% CI 0.612-0.929]; P=0.009), or female [OR 0.926, 95% CI 0.862-0.996]; P=0.04) had significantly lower odds for admission for surgery from the ED compared to White patients. Compared to individuals on Medicare, those with private insurance [OR 1.25, 95% CI 1.13-1.39; P <0.005) were significantly more likely to be admitted for emergent surgery, whereas those without insurance [OR 0.581, 95% CI 0.323-0.958; P=0.05) were significantly less likely to be admitted for emergent surgery. There was no significant difference in odds of admission for surgery between LEP vs non-LEP patients.
Individuals without health insurance and those identifying as female, Black, or Asian had significantly lower odds of admission for surgery from the ED compared to those with health insurance, males, and those self-identifying as White, respectively. Future studies should assess the reasons underpinning this finding to elucidate impact on patient outcomes.
英语水平和种族都被认为会独立影响手术机会和质量，但关于种族和有限英语水平（LEP）对从急诊部（ED）紧急手术入院的影响，人们知之甚少。我们的目的是研究种族和英语水平对从 ED 紧急手术入院的影响。
我们进行了一项回顾性观察队列研究，时间为 2019 年 1 月 1 日至 12 月 31 日，地点是一家大型四级城市学术医疗中心，拥有 66 张床位的 ED 一级创伤和烧伤中心。我们纳入了所有自我报告的种族的 ED 患者，这些患者报告首选语言不是英语，需要口译员或声明英语是他们的首选语言（对照组）。使用多变量逻辑回归来评估 LEP 状态、种族、年龄、性别、到达 ED 的方式、保险状况以及 LEP 状态与种族与从 ED 进行手术入院之间的相互作用与手术入院的关系。
共有 85899 名患者（48.1%为女性）纳入本分析，其中 3179 名（3.7%）患者因紧急手术入院。无论 LEP 状态如何，自我报告为黑人（比值比 [OR] 0.456，95%置信区间 [CI] 0.388-0.533；P<0.005）、亚洲人（OR 0.759，95% CI 0.612-0.929；P=0.009）或女性（OR 0.926，95% CI 0.862-0.996；P=0.04）的患者因 ED 入院进行手术的可能性明显低于白人患者。与医疗保险患者相比，与医疗保险相比，私人保险患者（OR 1.25，95% CI 1.13-1.39；P<0.005）更有可能接受紧急手术，而没有保险的患者（OR 0.581，95% CI 0.323-0.958；P=0.05）更不可能接受紧急手术。LEP 患者与非 LEP 患者之间接受手术的可能性没有显著差异。
与有医疗保险、男性和自我认同为白人的人相比，没有医疗保险的人以及自我认同为女性、黑人或亚洲人的人因 ED 手术入院的可能性明显降低。未来的研究应评估支持这一发现的原因，以阐明其对患者结局的影响。
