Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research

World Neurosurg. 2024 May:185:338-350.e1. doi: 10.1016/j.wneu.2024.02.068. Epub 2024 Feb 20.


Objective: In 2019, 22% of adults in the United States reported speaking a language other than English at home, representing 52% growth since 2000. This diversity in languages - and resulting possible communication barriers - represents a potential challenge to effective care. In this manuscript, we summarize clinical outcomes and healthcare utilization patterns of adult and pediatric neurosurgical patients who are non-English primary language speakers (NEPLS).

Methods: We systematically queried 5 databases from inception through October 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify studies for inclusion. The Newcastle-Ottawa Scale was used to assess the quality of studies. Additionally, a retrospective chart review was conducted to assess differences in postoperative communication patterns in a cohort of English and Spanish speaking patients with craniosynostosis at our institution.

Results: Our search yielded 442 abstracts; ten were included in the final cohort. Outcomes for 973 unique NEPLS with a neurosurgical condition were included; Spanish was the most represented language. Delivery and timing of surgical treatment was the most frequently reported metric; 75% of studies demonstrated a statistically significant delay in time to surgery or decreased likelihood for NEPLS to receive surgical treatment. Length of stay was reported in 3 studies; all demonstrated that NEPLS had longer length of stay.

Conclusions: There is a paucity of literature reporting outcomes among NEPLS. It is critical to examine NEPLS patients' outcomes and experiences, as language barriers are potentially modifiable demographic factors. We present a framework that demonstrates opportunities for further research to improve quality of care.

Keywords: Craniosynostosis; Healthcare disparities; Limited english proficiency; Quality of care; Social determinants of health; Systematic review.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Adult
  • Communication Barriers
  • Humans
  • Language
  • Neurosurgical Procedures*
  • Treatment Outcome