Language and gender barriers to pain control after general surgery

Effective pain control is crucial to postoperative recovery and is affected by biopsychosocial factors. This study aimed to evaluate how non-English primary language, gender, and marital status may influence pain, length of stay, and mortality after general surgery.

Consecutive general surgical admissions over a two-year period to two tertiary hospitals were included. Multivariable logistic regression analyses were conducted to evaluate the relationship between non-English primary language, gender, and marital status, and pain scores, length of stay, and in-hospital mortality. Explanatory variables that were controlled for in these analyses included age, birth country, whether a religion was specified, socioeconomic percentile, Charlson comorbidity index, and time of admission.

A total of 12 846 general surgery patients were included. When controlling for the aforementioned variables, including having a specified religion and being born overseas, having a non-English primary language was significantly independently associated with lower pain scores (odds ratio 0.61, 95% CI 0.52-0.71, P < 0.001). Female gender was independently associated with an increased likelihood of higher pain scores (odds ratio 1.09, 95% CI 1.01-1.18, P = 0.024) and a lower likelihood of prolonged length of stay (odds ratio 0.88, 95% CI 0. 80-0.95, P = 0.002). None of the evaluated variables had a statistically significant association with in-hospital mortality.

This study is the first to characterize an association between general surgery patients with a non-English primary language and lower levels of postoperative pain. It was also found that female gender was associated with higher postoperative pain but lower length of hospital stay.