Is Language a Barrier in the Management of Acute Appendicitis?

Overview

abstract

BACKGROUND: Language preference is a contributing factor for prolonged time from symptom onset to appendectomy within pediatrics, but is poorly characterized in adults. We aimed to investigate associations between language barriers and delays to assessment and treatment for adults with acute appendicitis. METHODS: In a multiethnic community, patients age ⪰18 years old who underwent appendectomy were identified between 1/2017-8/2022 at a single institution. Negative binomial regression was used to compare interval wait times to imaging, medication administration, and surgical evaluation between patients with limited English proficiency and those who are English proficient. RESULTS: Of the 1,469 patients included, 48% (n=699) had limited English proficiency. Average age was higher for patients with limited English proficiency (45 vs. 36, p<0.001) and majority were Asian (54%) and without private insurance (65%, p<0.001). Symptom duration, incidence of septic shock, and date/time of presentation to the Emergency Department were similar. Patients with limited English proficiency presented more frequently with gangrenous appendicitis (20% vs. 15%, p=0.013) but not perforated appendicitis (23% vs. 20%, p=0.065). They experienced longer wait times for surgical evaluation (376 vs. 348min, IRR 1.08, p=0.002) but similar times for imaging, and medications administered. On adjusted analysis for demographics, triage acuity, and hospital factors, longer wait times for surgical evaluation persisted (IRR adjusted 1.07, p=0.038). There was no significant difference in hospital length-of-stay, post-operative infection, or 30-day readmission rate. CONCLUSION: Adult patients with limited English proficiency may experience longer wait times for surgical evaluation for acute appendicitis, but this may not result in clinically significant delays in initiation of treatment.