Language preference, surgical wait time, and outcomes among older adults with hip fracture

Importance — Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may result from communication barriers and inequitable access to care.

Objective — To examine the association between non-English language preference with surgical wait time and post-operative outcomes in older patients undergoing hip fracture repair.

Design — A population-based, retrospective cohort study using linked databases to measure surgical wait time and post-operative outcomes among older adults who underwent hip fracture surgery between January 1, 2017 and December 31, 2022. We used propensity-based overlap weighting, accounting for baseline patient characteristics, to compare primary and secondary outcomes.

Setting — A retrospective population-based cohort study in Ontario, Canada. Participants: Community-dwelling older adults (66 years of age or older). Exposure: Non-English language preference.

Outcomes — Our primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, post-operative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission.

Results — Among 35,238 patients who underwent hip fracture surgery, 28,815 (81.8%) were English speakers (mean [SD] age 84.4 [8.0] years; 19,965 women [69.3%]) and 6,423 (18.2%) were non-English speakers (mean [SD] age 85.5 [7.0] years; 4,556 women [70.9%]). The median [IQR] wait time for surgery was similar for English (24 [16-41] hours) and non-English speakers (25 [16-42] hours). There was no significant difference in surgical delay beyond 24 hours between English and non-English speaking patients (51.7% vs. 50.3%, adjusted relative risk [aRR] 1.00, 95% confidence interval [CI] 0.98-1.03). Compared to English speakers, patients with a non-English language preference had increased risk of delirium (18.8% vs. 14.6%, RR 1.10, 95% CI 1.03-1.17), myocardial infarction (0.7% vs. 0.5%, aRR 1.52, 95% CI 1.04-2.22), longer length of stay (11 vs 10 days, aRR 1.11, 95% CI 1.06-1.15), and more frequent discharge to a nursing home (7.0% vs 6.8%, aRR 1.13, 95% CI 1.01-1.27).

Conclusions and relevance — In this cohort study of older adults undergoing hip fracture surgery, non-English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay and discharge to a nursing home. These findings indicate inequities in hip fracture care for patients with a non-English language preference.