Language Barriers in Appendicitis: What is the Cost?

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Abstract
Background: In clinical scenarios, pediatricians prefer patient history over imaging to diagnose pediatric appendicitis because they wish to limit their patients’ exposure to radiation. Language barriers between providers and patients with limited English proficiency may increase adverse outcomes, require more imaging studies, and lead to higher costs in cases of pediatric appendicitis. Methods: We queried the pediatric-National Surgical Quality Improvement Project database for patients under age 16 who received appendectomies from 2011-2021 at a single institution. Patients were propensity matched based on age, gender, Hispanic ethnicity, and insurance status. Medical records and hospital billing were merged to obtain primary language, initial hospitalization cost, diagnostic work up modalities, and operative findings. Patients identifying English as their primary language were termed English proficient (EP). Those selecting an alternate primary language made up the limited English proficiency (LEP) cohort. Health care utilization outcomes including cost, length of stay (LOS), and imaging usage were compared across cohorts. Results: 400 patients were matched for analysis: 92 were EP and 109 LEP. When compared with the EP cohort, patients with LEP had higher rates of diagnostic imaging, longer median LOS, and higher median hospital costs. Imaging costs were also higher in patients with LEP. We also observed higher rates of negative appendectomy in the EP patients, compared to the LEP cohort. Discussion: In patients with LEP, language diversity creates communication barriers resulting in higher health care utilization. Significant variations in the cost of care, efficiency of care, and clinical outcomes related to language diversity should be reduced to ensure equitable health care delivery to all pediatric surgical patients.

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