BACKGROUND: Preoperative decision-making in patients who speak a primary language other than English is understudied. We investigated whether patient primary language is associated with differences in immediate breast reconstruction (IBR) after mastectomy. PATIENTS AND METHODS: This retrospective observational study analyzed female patients undergoing mastectomy in the New Jersey State Inpatient Database (2009-2014). The primary outcome was the odds of IBR with a prespecified subanalysis of autologous tissue-based IBR. We used multivariable logistic regression and hierarchical generalized linear mixed models to control for patient characteristics and nesting within hospitals. RESULTS: Of 13,846 discharges, 12,924 (93.3%) specified English as the patient's primary language, while 922 (6.7%) specified a language other than English. Among English-speaking patients, 6178 (47.8%) underwent IBR, including 2310 (17.9%) autologous reconstructions. Among patients with a primary language other than English, 339 (36.8%) underwent IBR, including 93 (10.1%) autologous reconstructions. Unadjusted results showed reduced odds of IBR overall [odds ratio (OR) 0.64, 95% CI 0.55-0.73], and autologous reconstruction specifically (OR 0.52, 95% CI 0.41-0.64) among patients with a primary language other than English. After adjustment for patient factors, this difference persisted among the autologous subgroup (OR 0.64, 95% CI 0.51-0.80) but not for IBR overall. A hierarchical model incorporating both patient characteristics and hospital-level effects continued to show a difference among the autologous subgroup (OR 0.75, 95% CI 0.58-0.97). CONCLUSIONS: Primary language other than English was an independent risk factor for lower odds of autologous IBR after adjustments for patient and hospital effects. Focused efforts should be made to ensure that patients who speak a primary language other than English have access to high-quality shared decision-making for postmastectomy IBR.
BACKGROUND: Preoperative decision-making in patients who speak a primary language other than English is understudied. We investigated whether patient primary language is associated with differences in immediate breast reconstruction (IBR) after mastectomy. PATIENTS AND METHODS: This retrospective observational study analyzed female patients undergoing mastectomy in the New Jersey State Inpatient Database (2009-2014). The primary outcome was the odds of IBR with a prespecified subanalysis of autologous tissue-based IBR. We used multivariable logistic regression and hierarchical generalized linear mixed models to control for patient characteristics and nesting within hospitals. RESULTS: Of 13,846 discharges, 12,924 (93.3%) specified English as the patient's primary language, while 922 (6.7%) specified a language other than English. Among English-speaking patients, 6178 (47.8%) underwent IBR, including 2310 (17.9%) autologous reconstructions. Among patients with a primary language other than English, 339 (36.8%) underwent IBR, including 93 (10.1%) autologous reconstructions. Unadjusted results showed reduced odds of IBR overall [odds ratio (OR) 0.64, 95% CI 0.55-0.73], and autologous reconstruction specifically (OR 0.52, 95% CI 0.41-0.64) among patients with a primary language other than English. After adjustment for patient factors, this difference persisted among the autologous subgroup (OR 0.64, 95% CI 0.51-0.80) but not for IBR overall. A hierarchical model incorporating both patient characteristics and hospital-level effects continued to show a difference among the autologous subgroup (OR 0.75, 95% CI 0.58-0.97). CONCLUSIONS: Primary language other than English was an independent risk factor for lower odds of autologous IBR after adjustments for patient and hospital effects. Focused efforts should be made to ensure that patients who speak a primary language other than English have access to high-quality shared decision-making for postmastectomy IBR.
Authors: J Dauplat; F Kwiatkowski; P Rouanet; E Delay; K Clough; J L Verhaeghe; I Raoust; G Houvenaeghel; P Lemasurier; E Thivat; C Pomel Journal: Br J Surg Date: 2017-04-12 Impact factor: 6.939
Authors: Timothy Feeney; Michael Cassidy; Yorghos Tripodis; David McAneny; Maureen Kavanah; Teviah Sachs; Jennifer F Tseng; Frederick Thurston Drake Journal: Ann Surg Oncol Date: 2019-06-11 Impact factor: 5.344
Authors: Praveen Sridhar; Priya Misir; Hyunjee Kwak; Susanna Wl deGeus; Frederick T Drake; Michael R Cassidy; David A McAneny; Jennifer F Tseng; Teviah E Sachs Journal: J Am Coll Surg Date: 2019-06-15 Impact factor: 6.113
Authors: A C M van Bommel; K M de Ligt; K Schreuder; J H Maduro; T Van Dalen; M T F D Vrancken Peeters; M A M Mureau; S Siesling Journal: Eur J Surg Oncol Date: 2020-06-11 Impact factor: 4.424
Authors: Sainath Asokan; Praveen Sridhar; Muhammad M Qureshi; Maunil Bhatt; Minh Tam Truong; Kei Suzuki; Kimberley S Mak; Virginia R Litle Journal: Semin Thorac Cardiovasc Surg Date: 2019-12-19
Authors: Andri Thorarinsson; Victoria Fröjd; Lars Kölby; Johan Ljungdal; Charles Taft; Hans Mark Journal: Plast Reconstr Surg Glob Open Date: 2017-06-21