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Language-Concordant Preoperative Education Is Associated With Reduced Readmission Rates after Total Knee Arthroplasty
Oluwatofunmi Jummie Akinwunmi1, Wyatt H Buchalter2, Nattaly E Greene2
1Vagelos College of Physicians of Surgeons, Columbia University, New York, New York.
Background:
Language barriers in surgical care are linked to reduced patient satisfaction and care quality. Preoperative education improves patient understanding and postoperative outcomes, but its impact on disparities among non-English-speaking patients remains unclear. In January 2023, our institution implemented a Spanish-speaking nurse educator to provide language-concordant preoperative education to patients undergoing hip and knee arthroplasty. This study evaluated whether this intervention affected readmission rates compared to English-speaking patients.
Methods:
This retrospective, single-center cohort study included 1,381 total knee arthroplasty surgeries between January 2022 and January 2024, including 221 among Spanish-speaking patients. Demographic data and 30- and 90-day emergency department and inpatient readmissions were obtained from the electronic medical record. Patients were categorized by self-reported primary language. Difference-in-differences (DiDs) analyses assessed changes in readmission rates among Spanish-speaking patients after the nurse educator's implementation, compared to English-speaking patients over the same period. Multivariable logistic regressions adjusted for age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, and primary surgeon.
Results:
Before the intervention, Spanish-speaking patients had higher odds of 30- and 90-day readmission than English-speaking patients (odds ratio (OR) = 12.6, 95% confidence interval (CI) [2.32 to 99.4], P = 0.006; and OR = 6.25, 95% CI [1.62 to 27.5], P = 0.010, respectively). After the intervention, 30- and 90-day readmissions decreased for Spanish-speaking patients relative to English-speaking patients (DiD OR = 0.11, 95% CI [0.01 to 0.62], P = 0.019; and DiD OR = 0.18, 95% CI [0.04 to 0.74], P = 0.021). Spanish-speaking patients also demonstrated improvement in Western Ontario and McMaster Universities Osteoarthritis Index pain scores at one year (DiD Beta = -40 points, 95% CI [-76 to -5.2], P = 0.025).
Conclusion:
Implementation of a language-concordant nurse educator was associated with reduced readmissions and improved postoperative pain outcomes for Spanish-speaking patients undergoing TKA.