Association of Primary Language with Outcomes After Operations Typically Performed to Treat Cancer: Analysis of a Statewide Database

  • Timothy FeeneyEmail author
  • Michael Cassidy
  • Yorghos Tripodis
  • David McAneny
  • Maureen Kavanah
  • Teviah Sachs
  • Jennifer F. Tseng
  • Frederick Thurston Drake
Health Services Research and Global Oncology



Few studies have evaluated the effect of primary language on surgical outcomes, and no studies have addressed operations typically performed for cancer diagnoses. This study aimed to determine the effect of primary languages other than English on outcomes after surgical oncology operations.


This study retrospectively analyzed adults undergoing operations typically performed to treat cancer using the NJ Healthcare Cost and Utilization Project State Inpatient Database during the interval of 2009–2014. Language was grouped according to English-, Spanish-, and non-English/non-Spanish (NENS)-speaking groups. The study evaluated in-hospital mortality, 7-day readmission, and hospital length of stay (LOS). Logistic and negative binomial regression methods were applied, and generalized linear mixed models were used to account for nesting within a hospital.


This study analyzed 37,531 cases. Non-English speakers were of lower economic status, more likely to be admitted on the weekend, and more likely to undergo higher-risk operations. The likelihood of death in the risk-adjusted multi-level models did not differ between Spanish speakers (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.41–1.10) and NENS speakers (OR, 1.16; 95% CI, 0.77–1.75). Readmission rates exhibited high inter-hospital variability (intra-class correlation, 53%). The odds of readmission among Spanish speakers in the non-hierarchical model was increased (OR, 1.50; 95% CI, 1.11–2.02), but this was ameliorated in the multilevel modeling that accounted for variability between hospitals (OR, 1.29; 95% CI, 0.93–1.80). No changes in LOS were observed.


No independent association was observed between primary language and outcomes after operations typically performed to treat cancer in the study population. The higher proportion of weekend admissions may suggest more acute or advanced presentations for non-English speakers. Long-term outcomes may be necessary to discern an impact.



Dr. Feeney had full access to all the data in the study and takes responsibility for the integrity and accuracy of the analysis.


Timothy Feeney, Michael Cassidy, Yorghos Tripodis, David McAneny, Maureen Kavanah, Teviah Sachs, Jennifer F. Tseng, Frederick Thurston Drake have no conflicts of interest to declare.

Supplementary material

10434_2019_7484_MOESM1_ESM.eps (9 kb)
Fig. S1 Proportion of languages as a function of readmission proportion quarter. (EPS 8 kb)
10434_2019_7484_MOESM2_ESM.eps (9 kb)
Fig. S2 The readmission rate for each language group as a function of the overall readmission rate. The readmission rate is calculated as readmissions per language per total patients in the language group. (EPS 8 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Section of Surgical EndocrinologyBoston Medical CenterBostonUSA
  2. 2.Department of SurgeryBoston University School of MedicineBostonUSA
  3. 3.Section of Surgical OncologyBoston Medical CenterBostonUSA
  4. 4.Department of BiostatisticsBoston University School of Public HealthBostonUSA

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