The Impact of the Need for Language Assistance Services on the Use of Regional Anesthesia, Postoperative Pain Scores and Opioid Administration in Surgical Oncology Patients

Language barriers can negatively impact the quality of healthcare. In surgical patients, limited English proficiency (LEP) can lead to disparities in acute postoperative pain management. Interpreters are often used for communication with LEP patients to help alleviate these disparities. We aimed to investigate the impact of the need for language assistance services (LAS) in acute postoperative pain management in patients undergoing oncologic surgery. We retrospectively collected data on adult patients undergoing open abdominal oncologic surgery between March 2016 and August 2021. The need for LAS, patient demographics, treatment and clinical outcomes were obtained from the patient’s electronic medical record. The primary endpoint was pain intensity, while secondary endpoints included opioid use in PACU and regional anesthesia. Post-matching analysis (n = 590) demonstrated no significant difference in preoperative variables between patients needing LAS and those not needing LAS. The rate of regional use was slightly lower but not statistically significant in patients needing LAS. Patients needing LAS had significantly lower opioid consumption and reported lower pain intensity in PACU than subjects not requiring translation. In this study, LAS may have aided in the patient decision process regarding the acceptance of regional anesthesia. Although the need for LAS was associated with statistically significant lower pain intensity scores and a corresponding lesser opioid use than no LAS, the margin of differences, especially in pain intensity scores, may not be clinically significant. This may suggest that LAS allowed for better patient-provider communication and appropriate pain management.

[1]  Kevin H. Nguyen,et al.  Language barriers and postoperative opioid prescription use after total knee arthroplasty , 2022, Exploratory research in clinical and social pharmacy.

[2]  K. Lindquist,et al.  Limited English Proficiency Associated With Suboptimal Pain Assessment in Hospitalized Trauma Patients. , 2022, The Journal of surgical research.

[3]  J. Leyenaar,et al.  Inequities in Pain Assessment and Care of Hospitalized Children With Limited English Proficiency. , 2022, Hospital pediatrics.

[4]  Theresa A. Koleck,et al.  Do Limited English Proficiency and Language Moderate the Relationship Between Mental Health and Pain? , 2021, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[5]  K. Lapane,et al.  The Role of Limited English Proficiency and Access to Health Insurance and Health Care in the Affordable Care Act Era , 2020, Health equity.

[6]  H. Elser,et al.  Language-Related Disparities in Pain Management in the Post-Anesthesia Care Unit for Children Undergoing Laparoscopic Appendectomy , 2020, Children.

[7]  Hilal Salim Al Shamsi,et al.  Implications of Language Barriers for Healthcare: A Systematic Review , 2020, Oman medical journal.

[8]  T. Berdahl,et al.  Patient-Provider Communication Disparities by Limited English Proficiency (LEP): Trends from the US Medical Expenditure Panel Survey, 2006–2015 , 2018, Journal of General Internal Medicine.

[9]  K. Craig,et al.  Social communication model of pain. , 2015, Pain.

[10]  L. Morales,et al.  Patient-Reported Quality of Pain Treatment and Use of Interpreters in Spanish-Speaking Patients Hospitalized for Obstetric and Gynecological Care , 2012, Journal of General Internal Medicine.

[11]  R. Sinatra Causes and consequences of inadequate management of acute pain. , 2010, Pain medicine.

[12]  A. Urwyler,et al.  Language difficulties in outpatients and their impact on a chronic pain unit in Northwest Switzerland. , 2010, Swiss medical weekly.

[13]  Meredith Y. Smith,et al.  Self-efficacy for Coping With Cancer in a Multiethnic Sample of Breast Cancer Patients: Associations With Barriers to Pain Management and Distress , 2010, The Clinical journal of pain.

[14]  L. Morales,et al.  Impact of Interpreters on the Receipt of New Prescription Medication Information Among Spanish-Speaking Latinos , 2009, Medical care.

[15]  Glenn Flores,et al.  The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review , 2005, Medical care research and review : MCRR.

[16]  H. Kehlet,et al.  Effect of postoperative analgesia on surgical outcome. , 2001, British journal of anaesthesia.

[17]  D W Baker,et al.  Use and effectiveness of interpreters in an emergency department. , 1996, JAMA.