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J Reconstr Microsurg 2023; 39(09): 681-694
DOI: 10.1055/a-2040-1750
Original Article

Language Disparity Predicts Poor Patient-Reported Outcome and Follow-Up in Microsurgical Breast Reconstruction

Fei Wang
1   The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Evan Rothchild
1   The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Yi-Hsueh Lu
1   The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
,
Joseph A. Ricci
1   The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations Funding This study was approved by the Institutional Review Board at our institution and was not supported by any external sources of funding.
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Abstract

Background Patients with limited English proficiency (LEP) have starkly different health care experiences compared with their English-proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction.

Methods A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected included patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ 2 test, Student's t-test, odds ratio analysis, and regression modeling were used for analysis.

Results A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with an abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs. 499.3 minutes, p = 0.024), were more likely to have postoperative donor site revisions (p = 0.05), and more likely to receive preoperative neuraxial anesthesia (p = 0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p = 0.02). Interestingly, compared with LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow-up visits (p = 0.02). There were no significant differences in emergency room visits or complications between the cohorts.

Conclusion Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.

Keywords

Interpreters - limited English proficiency - microsurgical breast reconstruction - patient-reported outcomes

Author Contributions

All authors contributed to conceptualization and design; data collection, analysis and interpretation; drafting and revision; and manuscript approval.




Publication History

Received: 08 September 2022

Accepted: 08 January 2023

Accepted Manuscript online:
21 February 2023

Article published online:
23 March 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Commonly Asked Questions and Answers Regarding Limited English Proficient (LEP) Individuals. . In: LEP.gov
  • 2 Bureau USC. . About Language Use in the U.S. Population.2022
    PubMed
  • 3 Proctor K, Wilson-Frederick SM, Haffer SC. The limited English proficient population: describing Medicare, Medicaid, and dual beneficiaries. Health Equity 2018; 2 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 4 Cano-Ibáñez N, Zolfaghari Y, Amezcua-Prieto C, Khan KS. Physician-patient language discordance and poor health outcomes: a systematic scoping review. Front Public Health 2021; 9: 629041
    CrossrefPubMedGoogle Scholar
  • 5 Hsueh L, Hirsh AT, Maupomé G, Stewart JC. Patient-provider language concordance and health outcomes: a systematic review, evidence map, and research agenda. Med Care Res Rev 2021; 78 (01) 3-23
    CrossrefPubMedGoogle Scholar
  • 6 Derose KP, Baker DW. Limited English proficiency and Latinos' use of physician services. Med Care Res Rev 2000; 57 (01) 76-91
    CrossrefPubMedGoogle Scholar
  • 7 Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are Latinos less satisfied with communication by health care providers?. J Gen Intern Med 1999; 14 (07) 409-417
    CrossrefPubMedGoogle Scholar
  • 8 Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health 2005; 95 (08) 1410-1416
    CrossrefPubMedGoogle Scholar
  • 9 Ngo-Metzger Q, Sorkin DH, Phillips RS. et al. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med 2007; 22 Suppl 2 (Suppl. 02) 324-330
    CrossrefPubMedGoogle Scholar
  • 10 Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care 1988; 26 (12) 1119-1128
    CrossrefPubMedGoogle Scholar
  • 11 Wilson E, Chen AHM, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005; 20 (09) 800-806
    CrossrefPubMedGoogle Scholar
  • 12 Karliner LS, Auerbach A, Nápoles A, Schillinger D, Nickleach D, Pérez-Stable EJ. Language barriers and understanding of hospital discharge instructions. Med Care 2012; 50 (04) 283-289
    CrossrefPubMedGoogle Scholar
  • 13 Molina RL, Kasper J. The power of language-concordant care: a call to action for medical schools. BMC Med Educ 2019; 19 (01) 378
    CrossrefPubMedGoogle Scholar
  • 14 Kang S-Y, Howard D, Kim J. et al. English language proficiency and lifetime mental health service utilization in a national representative sample of Asian Americans in the USA. J Public Health (Oxf) 2010; 32 (03) 431-439
    CrossrefPubMedGoogle Scholar
  • 15 Anderson N, Janarious A, Liu S, Flanagan LA, Stradling D, Yu W. Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke. BMC Neurol 2020; 20 (01) 363
    CrossrefPubMedGoogle Scholar
  • 16 Forrow L, Kontrimas JC. Language barriers, informed consent, and effective caregiving. J Gen Intern Med 2017; 32 (08) 855-857
    CrossrefPubMedGoogle Scholar
  • 17 Lee JS, Pérez-Stable EJ, Gregorich SE. et al. Increased access to professional interpreters in the hospital improves informed consent for patients with limited English proficiency. J Gen Intern Med 2017; 32 (08) 863-870
    CrossrefPubMedGoogle Scholar
  • 18 Patel DN, Wakeam E, Genoff M, Mujawar I, Ashley SW, Diamond LC. Preoperative consent for patients with limited English proficiency. J Surg Res 2016; 200 (02) 514-522
    CrossrefPubMedGoogle Scholar
  • 19 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124 (02) 345-353
    CrossrefPubMedGoogle Scholar
  • 20 Bassiri-Tehrani B, Karanetz I, Bernik SF, Dec W, Lehman JC, Lerman OZ. The timing of chemoprophylaxis in autologous microsurgical breast reconstruction. Plast Reconstr Surg 2018; 142 (05) 1116-1123
    CrossrefPubMedGoogle Scholar
  • 21 Opsomer D, Vyncke T, Depypere B, Stillaert F, Van Landuyt K, Blondeel P. Nipple reconstruction in autologous breast reconstruction after areola-sparing mastectomy. J Plast Reconstr Aesthet Surg 2021; 74 (06) 1223-1228
    CrossrefPubMedGoogle Scholar
  • 22 Teotia SS, Dickey RM, Liu Y, Jayaraman AP, Haddock NT. Intraoperative microvascular complications in autologous breast reconstruction: the effects of resident training on microsurgical outcomes. J Reconstr Microsurg 2021; 37 (04) 309-314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Bureau USC. . About Language Use in the U.S. Population. 2021
    PubMed
  • 24 Debbink MP, Ugwu LG, Grobman WA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic inequities in cesarean birth and maternal morbidity in a low-risk, nulliparous cohort. Obstet Gynecol 2022; 139 (01) 73-82
    CrossrefPubMedGoogle Scholar
  • 25 Edmonds JK, Hawkins SS, Cohen BB. Variation in vaginal birth after cesarean by maternal race and detailed ethnicity. Matern Child Health J 2016; 20 (06) 1114-1123
    CrossrefPubMedGoogle Scholar
  • 26 Mattocks KM, Kroll-Desrosiers A, Kinney R. et al. Racial differences in the cesarean section rates among women veterans using Department of Veterans Affairs Community Care. Med Care 2021; 59 (02) 131-138
    CrossrefPubMedGoogle Scholar
  • 27 Yee LM, Costantine MM, Rice MM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates. Obstet Gynecol 2017; 130 (06) 1285-1294
    CrossrefPubMedGoogle Scholar
  • 28 Kern-Goldberger AR, Booker W, Friedman A, Gyamfi-Bannerman C. Racial and ethnic disparities in cesarean morbidity. Am J Perinatol 2021
    PubMedGoogle Scholar
  • 29 Unukovych D, Caterson EJ, Carty MJ, Erdmann-Sager J, Halvorson E, Caterson SA. Bilateral free flap breast reconstruction outcomes: do abdominal scars affect bilateral flaps?. Plast Reconstr Surg Glob Open 2017; 5 (09) e1493
    CrossrefPubMedGoogle Scholar
  • 30 Lee KT, Mun GH. Effects of obesity on postoperative complications after breast reconstruction using free muscle-sparing transverse rectus abdominis myocutaneous, deep inferior epigastric perforator, and superficial inferior epigastric artery flap: a systematic review and meta-analysis. Ann Plast Surg 2016; 76 (05) 576-584
    CrossrefPubMedGoogle Scholar
  • 31 Masoomi H, Fairchild B, Marques ES. Frequency and predictors of 30-Day surgical site complications in autologous breast reconstruction surgery. World J Plast Surg 2019; 8 (02) 200-207
    CrossrefPubMedGoogle Scholar
  • 32 Voineskos SH, Frank SG, Cordeiro PG. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes. Gland Surg 2015; 4 (06) 484-496
    PubMedGoogle Scholar
  • 33 Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet 2003; 361 (9374): 2032-2035
    CrossrefPubMedGoogle Scholar
  • 34 Lee CT, Dunn RL, Chen BT, Joshi DP, Sheffield J, Montie JE. Impact of body mass index on radical cystectomy. J Urol 2004; 172 (4 Pt 1): 1281-1285
    CrossrefPubMedGoogle Scholar
  • 35 Silber JH, Rosenbaum PR, Zhang X, Even-Shoshan O. Influence of patient and hospital characteristics on anesthesia time in Medicare patients undergoing general and orthopedic surgery. Anesthesiology 2007; 106 (02) 356-364
    CrossrefPubMedGoogle Scholar
  • 36 Caballero JA, Butwick AJ, Carvalho B, Riley ET. Preferred spoken language mediates differences in neuraxial labor analgesia utilization among racial and ethnic groups. Int J Obstet Anesth 2014; 23 (02) 161-167
    CrossrefPubMedGoogle Scholar
  • 37 Toledo P, Eosakul ST, Grobman WA, Feinglass J, Hasnain-Wynia R. Primary spoken language and neuraxial labor analgesia use among Hispanic Medicaid recipients. Anesth Analg 2016; 122 (01) 204-209
    CrossrefPubMedGoogle Scholar
  • 38 Al-Harthy M, Ohrbach R, Michelotti A, List T. The effect of culture on pain sensitivity. J Oral Rehabil 2016; 43 (02) 81-88
    CrossrefPubMedGoogle Scholar
  • 39 Orhan C, Van Looveren E, Cagnie B, Mukhtar NB, Lenoir D, Meeus M. Are pain beliefs, cognitions, and behaviors influenced by race, ethnicity, and culture in patients with chronic musculoskeletal pain: a systematic review. Pain Physician 2018; 21 (06) 541-558
    PubMedGoogle Scholar
  • 40 Jamison L, Kolakowsky-Hayner SA, Wright J. Preliminary investigation of longitudinal sociodemographic, injury and psychosocial characteristics in a group of non-English speaking Latinos with brain injury. Brain Inj 2012; 26 (06) 805-813
    CrossrefPubMedGoogle Scholar
  • 41 Lebrun LA. Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States. Soc Sci Med 2012; 74 (07) 1062-1072
    CrossrefPubMedGoogle Scholar
  • 42 Colvin J, Dawson DV, Gu H, Marchini L. Patient expectation and satisfaction with different prosthetic treatment modalities. J Prosthodont 2019; 28 (03) 264-270
    CrossrefPubMedGoogle Scholar
  • 43 Bustos VP, Xun H, McLarney J. et al. Misconceptions, myths, and mystery: a cross-sectional survey study on public knowledge and values of microsurgery. J Reconstr Microsurg 2022; (e-pub ahead of print). doi. DOI: 10.1055/a-1896-5598.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Kamel GN, Nash D, Jacobson J. et al. Patient-reported satisfaction and quality of life in postmastectomy radiated patients: a comparison between delayed and delayed immediate autologous breast reconstruction in a predominantly minority patient population. J Reconstr Microsurg 2019; 35 (06) 445-451
    Article in Thieme ConnectPubMedGoogle Scholar