Language-Concordant Preoperative Education is Associated with Reduced Readmission Rates After Total Knee Arthroplasty.

Abstract

Language barriers in surgical care are linked to reduced patient satisfaction and care quality. Preoperative education improves patient understanding and postoperative outcomes, but its impact on disparities among non-English-speaking patients remains unclear. In January 2023, our institution implemented a Spanish-speaking nurse educator to provide language-concordant preoperative education to patients undergoing hip and knee arthroplasty. This study evaluated whether this intervention affected readmission rates compared to English-speaking patients. This retrospective, single-center cohort study included 1,381 total knee arthroplasty (TKA) surgeries between January 2022 and January 2024, including 221 among Spanish-speaking patients. Demographic data and 30- and 90-day emergency department and inpatient readmissions were obtained from the electronic medical record. Patients were categorized by self-reported primary language. Difference-in-differences (DiD) analyses assessed changes in readmission rates among Spanish-speaking patients after the nurse educator's implementation, compared to English-speaking patients over the same period. Multivariable logistic regressions adjusted for age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, and primary surgeon. Before the intervention, Spanish-speaking patients had higher odds of 30- and 90-day readmission than English-speaking patients (odds ratio (OR) = 12.6, 95% confidence interval (CI) [2.32 to 99.4], P = 0.006; and OR = 6.25, 95% CI [1.62 to 27.5], P = 0.010, respectively). After the intervention, 30- and 90-day readmissions decreased for Spanish-speaking patients relative to English-speaking patients (DiD OR = 0.11, 95% CI [0.01 to 0.62], P = 0.019; and DiD OR = 0.18, 95% CI [0.04 to 0.74], P = 0.021). Spanish-speaking patients also demonstrated improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scores at one year (DiD Beta = -40 points, 95% CI [-76 to -5.2], P = 0.025). Implementation of a language-concordant nurse educator was associated with reduced readmissions and improved postoperative pain outcomes for Spanish-speaking patients undergoing TKA.