TY - JOUR
T1 - The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management
AU - Segal, Kathryn R.
AU - Gomez, Jaime A.
AU - Schulz, Jacob F.
AU - Alvandi, Leila Mehraban
AU - Fornari, Eric D.
N1 - Publisher Copyright:
Copyright © 2023 by the American Academy of Pediatrics.
PY - 2023/11
Y1 - 2023/11
N2 - BACKGROUND AND OBJECTIVES: Inpatient postoperative care is reliant upon clear, open communication between providers and patient–families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS: This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children’s hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient–families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS: A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P 5.03), consumed 0.53 fewer benzodiazepine medications per day (P 5.01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P 5.03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15–8.85). CONCLUSIONS: As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
AB - BACKGROUND AND OBJECTIVES: Inpatient postoperative care is reliant upon clear, open communication between providers and patient–families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS: This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children’s hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient–families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS: A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P 5.03), consumed 0.53 fewer benzodiazepine medications per day (P 5.01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P 5.03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15–8.85). CONCLUSIONS: As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
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U2 - 10.1542/hpeds.2023-007232
DO - 10.1542/hpeds.2023-007232
M3 - Article
C2 - 37850258
AN - SCOPUS:85176798421
SN - 2154-1663
VL - 13
SP - 1001
EP - 1009
JO - Hospital Pediatrics
JF - Hospital Pediatrics
IS - 11
ER -