The effect of Section 1557 of the Affordable Care Act on surgical outcomes in non-English primary language speakers

Abstract

BackgroundIn 2016, Section 1557 mandated use of qualified language interpreter services. We examined the effect of Section 1557 on surgical outcomes. MethodsUtilizing the Healthcare Cost and Utilization Project State Inpatient Database (2013–2020), we performed a difference-in-differences analysis of adult surgical patients (Maryland, New Jersey). The exposure was implementation of Section 1557 (pre-period: 2013–2015; post-period: 2017–2020). The treatment group was non-English primary language speakers (n-EPL). The comparison group was English primary language speakers (EPL). Outcomes included length-of-stay, postoperative complications, mortality, discharge disposition, and readmissions. ResultsAmong 2,298,584 patients, 198,385 (8.6%) were n-EPL. After implementation of Section 1557, n-EPL saw no difference in readmission rates but did experience significantly higher rates of mortality (+0.43%, p ​= ​0.049) and non-routine discharges (+1.81%, p ​= ​0.031) in Maryland, and higher rates of post-operative complications (+0.31%, p ​= ​0.001) in both states, compared to pre-Section 1557. ConclusionsContrary to our hypothesis, Section 1557 did not improve surgical outcomes for n-EPL.