Language Preference, Surgical Wait Time, and Outcomes Among Older Adults With Hip Fracture

Abstract

Importance: Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care.

Objective: To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair.

Design, setting, and participants: This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022. Propensity-based overlap weighting accounting for baseline patient characteristics was used to compare primary and secondary outcomes.

Exposure: Non-English language preference.

Main outcomes and measures: The primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, postoperative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission.

Results: Among 35 238 patients who underwent hip fracture surgery, 28 815 individuals (81.8%) were English speakers (mean [SD] age, 84.4 [8.0] years; 19 965 female [69.3%]) and 6423 individuals (18.2%) were non-English speakers (mean [SD] age, 85.5 [7.0] years; 4556 female [70.9%]). The median (IQR) wait time for surgery was similar for English (24 [16-41] hours) and non-English (25 [16-42] hours) speakers. There was no significant difference in surgical delay beyond 24 hours between English-speaking and non-English-speaking patients (3321 patients [51.7%] vs 14 499 patients [50.3%]; adjusted relative risk [aRR], 1.00; 95% CI, 0.98-1.03). Compared with English speakers, patients with a non-English language preference had increased risk of delirium (4207 patients [14.6%] vs 1209 patients [18.8%]; aRR, 1.10; 95% CI, 1.03-1.17), myocardial infarction (150 patients [0.5%] vs 43 patients [0.7%]; aRR, 1.52; 95% CI, 1.04-2.22), longer length of stay (median [IQR], 10 [6-17] vs 11 [7-20] days; aRR per 1-day increase, 1.11; 95% CI, 1.06-1.15), and more frequent discharge to a nursing home (1814 of 26 673 patients surviving to discharge [6.8%] vs 413 of 5903 patients surviving to discharge [7.0%]; aRR, 1.13; 95% CI, 1.01-1.27).

Conclusions and relevance: In this study of older adults with hip fracture, non-English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay, and discharge to a nursing home. These findings suggest inequities in hip fracture care for patients with a non-English language preference.