Association Between Language, Interpreter Use, and Pediatric Surgical Outcomes

Background: Inequities exist in pediatric surgical outcomes. Differential outcomes have been identified across racial groups, geography, and socioeconomic standing. However, the association between preferred language, interpreter use, and surgical outcomes is not well-studied in pediatric surgical literature.

Methods: We performed a retrospective cohort study of surgical patients ages 0-21 years at a quaternary pediatric hospital between 1/1/2016 - 12/31/2020. The 95 languages spoken by our cohort were grouped into English, Spanish, Asian languages, Other Indo-European languages, and Other languages. Study outcomes were 30-day post-operative mortality and serious adverse events (SAE). Logistic regression assessed the relationship between language, interpreter use, and post-operative outcomes. Deviation contrasts avoided centering non-Hispanic white English speakers. All-pairs comparisons (Turkey contrasts) determined differences between language groups.

Results: Among 56,655 patients, 89 % had a documented language of English, 6.7 % Spanish, 1.4 % Other, 1.3 % an Asian language, and 1.3 % an Other Indo-European language. On multivariable regression, English speakers had 54 % decreased odds of mortality (OR 0.46, 95 % CI: 0.31, 0.69), while Other language speakers had 240 % increased odds of mortality (OR 2.4, 95 % CI: 1.31, 4.41). Pairwise comparisons showed that English language speakers had reduced odds of mortality versus Other language speakers (OR 0.18, 95 % CI: 0.07, 0.45). Interpreter use was associated with a significant reduction in the odds of SAE but did not reduce mortality risk.

Discussion: Pediatric surgical patients with a linguistic minority preference experienced statistically significant increased odds of post-operative mortality. Additional inquiry to assess and address disparate pediatric surgical care outcomes associated with language is warranted.

Level of evidence: Level III.