EP550 - Disparities in Surgical Presentation for Patients with Limited English Proficiency Undergoing Major Colorectal Surgery

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Purpose/Background: Colorectal surgery conditions require complex conversations and multiple interactions within the healthcare system, potentially resulting in different timing of surgical presentation for patients with limited English proficiency (LEP). We investigated the association between patient primary language and access to colorectal surgery within two large state datasets.

Methods/Interventions: HRQ’s HCUP New Jersey (NJ) and Maryland (MD) State Inpatient Databases from 2010-2019 were assessed for adults with known primary language who underwent major colorectal surgery. Primary exposure was English versus non-English primary language (NEPL). Additional analysis divided NEPL into Spanish and non-English/non-Spanish primary language (NENSPL). Primary outcome was urgent/emergent admission, which was utilized as a proxy for delayed presentation. Data was stratified by state and Hispanic ethnicity for subgroup analyses. Multivariable logistic regression adjusted for patient and county-level variables.

Results/Outcomes: Of 104,642 patients, 7,957 (7.6%) had NEPL and 87,849 (84%) were hospitalized in NJ. The rate of urgent/emergent admission by patient language was 45.8% for English, 51.9% for Spanish, and 54.1% for NENSPL. These differences were consistent when stratified by MD and NJ cohorts, although the rates of urgent/emergent admission were lower for all cohorts in MD compared to NJ (Table 1). Patients with NEPL were statistically more likely to be male, non-White, with Medicaid insurance, and have fewer comorbidities. After multivariable adjustment, compared those who speak English, patients with NEPL and NENSPL had significantly higher odds of urgent admission (ORs 1.13 and 1.25, respectively), but patients who preferred Spanish did not (OR 0.99) (Table 1). Though these trends persisted within each state, in MD the odds of urgent/emergent admission were 50-55% higher, while in NJ they were only 10-21% higher than their English-speaking counterparts. Among Hispanic patients, those who had a Spanish primary language had 28% higher odds of urgent/emergent admission (95%CI: 1.03-1.59).

Conclusion/Discussion: Patients with LEP have significantly higher odds of presenting urgently or emergently for colorectal surgeries, which is persistent across multiple states. The magnitude of this finding is likely an underestimate, as it does not include patients who are unable to make it to surgery due significantly delayed presentation or inability to access the healthcare system. Among patients with NEPL, those with NENSPL have worse outcomes, emphasizing the need to further stratify patients with LEP into specific languages when possible. Finally, our results within the Hispanic subgroup analysis demonstrate that these differences may be specifically driven by language and communication, rather than ethnic or cultural differences. Further investigation through mixed-method studies is needed to determine causal pathways.