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American Association for Hand Surgery

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Investigating Disparities in Hand Surgery Outcomes for Spanish-speaking Patients
Victoria G Zeyl, BA1, Kiara M Corcoran Ruiz, AB1, Rodrigo A Saad Berreta, BA1, Joseph W Crozier, MA2 and Loree K Kalliainen, MD3, (1)Warren Alpert Medical School at Brown University, Providence, RI, (2)Lifespan Physician Group, Providence, RI, (3)Plastic and Hand Surgery, Warren Alpert Medical School of Brown University, Providence, RI

Introduction
As the Spanish-speaking population in the United States continues to increase, analysis of differences in surgical outcomes will become increasingly important to address potential disparities. The purpose of this study is to identify areas in which hand injury outcomes differ between Spanish-speaking (SS) and English-speaking (ES) patients.
Materials & Methods
A retrospective chart review of patients who underwent hand surgery within a Rhode Island healthcare system between January 2015 and December 2020 was conducted. Comparison groups were determined by patients' primary language preference, Spanish or English. Demographics such as age, gender, and insurance status were collected. Clinical information was collected including patient comorbidities, surgical re-interventions, return to work date, pain management regimen, and post-surgical hand therapy utilization. Univariate and multivariate analyses were performed to compare population characteristics and outcomes. We established significance at the 95% level.
Results
A total of 178 patients were included and grouped by primary language. The SS (n=89) group and ES (n=89) group were similar in age and gender yet differed significantly by insurance status with more insured ES patients (92.1%) than SS patients (71%) (p < 0.001). Significantly fewer SS patients received care instructions in their primary language compared to ES patients (p<0.001). ES patients had, on average, more operations (2.34) for the same hand injury when compared to SS patients (1.72) (p=0.015). Despite similar rates of workers compensation insurance (BWC) (p=0.79), SS patients were 39% less likely to have occupational hand therapy (OT) sessions when adjusted for comorbidities, age, gender and BWC (adjusted odds ratio (aOR) = 0.61, 95% CI = 0.41 - 0.93).
Conclusions
Differences exist in postoperative outcomes between SS and ES patients. Fewer SS patients received instructions in their primary language, which may contribute to miscommunication or misunderstanding of post-operative care. Furthermore, significantly more SS were uninsured, received fewer surgical re-interventions and were more likely to have fewer OT sessions. SS patients with hand trauma represent a growing population that may benefit from targeted intervention and investigation to improve care and outcomes.


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