title: The relationship between language proficiency and surgical length of stay following cardiac bypass surgery.
abstract: Anglophone nurses face the challenge of communicating health information to patients who do not speak or understand English. Limited English-proficient patients are at higher risk of misinterpreting health information teaching. Successful recovery after coronary artery bypass graft surgery requires patients' engagement with healthcare professionals and active participation in therapies and related undertakings. Determination of whether limited English-proficient patients undergoing coronary artery bypass graft surgery recover at the same pace as the general population is of interest.
  
  
  
  This study examined whether limited English-proficient patients had prolonged post-operative length of stay following coronary artery bypass graft surgery. The patients' length of stay with regard to a clinical pathway target was also examined.
  
  
  
  A retrospective medical record review of all patients undergoing isolated coronary artery bypass graft surgery in a 2-year period was conducted. A screening tool was developed to identify limited English-proficient patients through examination of their medical records.
  
  
  
  A total of 691 of 712 (97.1%) patients met the inclusion criteria; 103 (14.9%) patients were identified as limited English-proficient. The post-operative median length of stay of limited English-proficient patients was 7 days compared with 6 days for the English-proficient patients (p = 0.007). Limited English-proficient patients had higher infection rates (29.1%) vs. English-proficient patients (16.7%) (odds ratio = 2.05 (95% confidence intervals 1.27-3.30)). Post-operative infection was the strongest predictor of length of stay and fully mediated the relationship between language proficiency and length of stay.
  
  
  
  When compared with English-proficient patients, limited English-proficient patients had greater infection rates, which were associated with longer length of stay. These findings warrant examination of the mechanisms through which post-operative infections are acquired by limited English-proficient patients.
authors.affiliation: Vancouver General Hospital, Cardiac Services, Canada erin.tang@vch.ca.
authors.forename: Erin W
authors.initials: EW
authors.lastname: Tang
authors.affiliation: Vancouver General Hospital, Cardiac Services, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Go
authors.affiliation: Vancouver General Hospital, Cardiac Services, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kwok
authors.affiliation: Vancouver General Hospital, Cardiac Services, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Leung
authors.affiliation: The Heart Centre, St. Paul's Hospital, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Lauck
authors.affiliation: School of Nursing and Centre for Health Services and Policy Research, The University of British Columbia, Canada.
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Wong
authors.affiliation: Vancouver General Hospital, Cardiac Services, Canada.
authors.forename: Priscilla G
authors.initials: PG
authors.lastname: Taipale
authors.affiliation: Faculty of Education, The University of British Columbia, Canada.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003144:Communication Barriers; D001026:Coronary Artery Bypass / Q000523:psychology*; D005260:Female; D006801:Humans; D007802:Language; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D014175:Translating
keywords: Cardiovascular surgery; communication; language proficiency; length of stay; post-operative care