PDF(Pubmed)
Abstract：
BACKGROUND: Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery.
OBJECTIVE: This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.
METHODS: This was a retrospective cohort study comparing perioperative outcomes between non-English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample t tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.
RESULTS: Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non-English-speaking group was younger (57 vs 54 years old, respectively; P<.01) and had lower rates of depression (26% vs 14%, respectively; P<.01) and chronic pain (13% vs 6%, respectively; P<.01). Although non-English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; P=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non-English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; P<.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; P<.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (P=.02 and P=.04, respectively) than non-English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hospital cohort and similar oral morphine equivalents at the time of discharge compared with non-English-speaking patients.
CONCLUSIONS: Patients who do not speak English may be at risk of undertreated pain in the immediate postoperative setting. Language barrier, frequency of pain assessments, and provider bias may perpetuate disparity in pain management. Based on this study\'s findings, we advocate for the use of regular verbal pain assessments with language-concordant staff or medical interpreters for all postoperative patients.
OBJECTIVE: This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.
METHODS: This was a retrospective cohort study comparing perioperative outcomes between non-English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample t tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.
RESULTS: Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non-English-speaking group was younger (57 vs 54 years old, respectively; P<.01) and had lower rates of depression (26% vs 14%, respectively; P<.01) and chronic pain (13% vs 6%, respectively; P<.01). Although non-English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; P=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non-English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; P<.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; P<.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (P=.02 and P=.04, respectively) than non-English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hospital cohort and similar oral morphine equivalents at the time of discharge compared with non-English-speaking patients.
CONCLUSIONS: Patients who do not speak English may be at risk of undertreated pain in the immediate postoperative setting. Language barrier, frequency of pain assessments, and provider bias may perpetuate disparity in pain management. Based on this study\'s findings, we advocate for the use of regular verbal pain assessments with language-concordant staff or medical interpreters for all postoperative patients.
摘要：
背景：疼痛管理中的种族和种族差异有很好的记录。在妇科手术的术后设置中，尚未研究疼痛评估和语言管理的差异。
目的：本研究旨在通过比较非英语使用者和英语使用者的疼痛评估和围手术期阿片类药物使用情况，探讨语言与术后即刻疼痛管理之间的关系。
方法：这是一项回顾性队列研究，比较了2012年7月至2020年12月期间接受妇科肿瘤开放手术的非英语患者和英语患者的围手术期结局。主要语言是从电子病历中提取的。阿片类药物的使用表现为口服吗啡等价物。使用卡方检验比较比例，和平均值使用2样本t检验进行比较。尽管我们的机构广泛提供口译服务，没有记录在任何给定的住院患者-提供者互动中使用口译员的情况.
结果：在2012年至2020年之间，1203名妇科肿瘤患者接受了开放手术，其中181人(15.1%)是非英语使用者，1018人(84.9%)是英语使用者。关于体重指数的两个队列之间没有差异，手术风险评分,或术前使用阿片类药物。与讲英语的群体相比，非英语群体更年轻(57岁vs54岁，分别为；P<.01)，抑郁发生率较低(26%vs14%，分别为；P<0.01)和慢性疼痛(13%vs6%，分别为；P<0.01）。尽管非英语患者的子宫切除率高于英语患者（80％vs72％，分别；P=0.03)，肠切除率没有差异,附件手术,手术的长度，术中口服吗啡等效物，失血,使用阿片类药物保留方式，住院时间,或重症监护病房入院。在术后期间，与说英语的病人相比，非英语患者每天口服吗啡当量较少(31.7比43.9口服吗啡当量，分别；P<.01），并且疼痛评估频率较低（每天检查7.7vs8.8，分别为；P<0.01)术后。说英语的患者每天在医院接受的口服吗啡当量中位数增加19.5个单位，出院时口服吗啡当量中位数增加205.1个单位（分别为P=.02和P=.04）。说英语的患者。当控制组间差异和可能影响口服吗啡等效使用的几个因素时，与不讲英语的患者相比，在医院队列中，讲英语的患者每天平均接受15.9个单位的口服吗啡当量，出院时类似的口服吗啡当量。
结论：不会说英语的患者在术后即刻可能存在疼痛治疗不足的风险。语言障碍,疼痛评估的频率，提供者的偏见可能会使疼痛管理方面的差距长期存在。根据这项研究的发现，我们主张对所有术后患者使用语言一致的工作人员或医疗翻译进行定期的口头疼痛评估.
目的：本研究旨在通过比较非英语使用者和英语使用者的疼痛评估和围手术期阿片类药物使用情况，探讨语言与术后即刻疼痛管理之间的关系。
方法：这是一项回顾性队列研究，比较了2012年7月至2020年12月期间接受妇科肿瘤开放手术的非英语患者和英语患者的围手术期结局。主要语言是从电子病历中提取的。阿片类药物的使用表现为口服吗啡等价物。使用卡方检验比较比例，和平均值使用2样本t检验进行比较。尽管我们的机构广泛提供口译服务，没有记录在任何给定的住院患者-提供者互动中使用口译员的情况.
结果：在2012年至2020年之间，1203名妇科肿瘤患者接受了开放手术，其中181人(15.1%)是非英语使用者，1018人(84.9%)是英语使用者。关于体重指数的两个队列之间没有差异，手术风险评分,或术前使用阿片类药物。与讲英语的群体相比，非英语群体更年轻(57岁vs54岁，分别为；P<.01)，抑郁发生率较低(26%vs14%，分别为；P<0.01)和慢性疼痛(13%vs6%，分别为；P<0.01）。尽管非英语患者的子宫切除率高于英语患者（80％vs72％，分别；P=0.03)，肠切除率没有差异,附件手术,手术的长度，术中口服吗啡等效物，失血,使用阿片类药物保留方式，住院时间,或重症监护病房入院。在术后期间，与说英语的病人相比，非英语患者每天口服吗啡当量较少(31.7比43.9口服吗啡当量，分别；P<.01），并且疼痛评估频率较低（每天检查7.7vs8.8，分别为；P<0.01)术后。说英语的患者每天在医院接受的口服吗啡当量中位数增加19.5个单位，出院时口服吗啡当量中位数增加205.1个单位（分别为P=.02和P=.04）。说英语的患者。当控制组间差异和可能影响口服吗啡等效使用的几个因素时，与不讲英语的患者相比，在医院队列中，讲英语的患者每天平均接受15.9个单位的口服吗啡当量，出院时类似的口服吗啡当量。
结论：不会说英语的患者在术后即刻可能存在疼痛治疗不足的风险。语言障碍,疼痛评估的频率，提供者的偏见可能会使疼痛管理方面的差距长期存在。根据这项研究的发现，我们主张对所有术后患者使用语言一致的工作人员或医疗翻译进行定期的口头疼痛评估.
