SAN ANTONIO — A recent study presented at the ANESTHESIOLOGY® 2025 annual meeting has highlighted a concerning trend: older patients who primarily speak a language other than English face a heightened risk of developing delirium following surgery in U.S. hospitals. The research further indicates that a lower socioeconomic status exacerbates this risk.
Postoperative delirium, a significant complication among older adults, manifests as a change in mental function that can lead to confusion in up to 15% of surgical patients. This incidence is even higher in high-risk groups, such as those with hip fractures.
“Our study provides evidence that speaking a first or primary language other than English is an independent risk factor for delirium in U.S. patients undergoing anesthesia for surgery,” stated Maximilian Schaefer, M.D., Ph.D., the study’s senior author and director of the Center for Anesthesia Excellence at Beth Israel Deaconess Medical Center. “We also found that delirium in these patients contributed to longer hospital stays, which can further delay recovery.”
Understanding the Language Barrier
The U.S. healthcare system is increasingly serving a diverse population, including many whose first language is not English. Language barriers can lead to confusion and agitation before and after surgery, both of which are associated with the development of postoperative delirium.
The study analyzed data from 49,588 patients aged 60 or older who underwent general anesthesia for non-cardiac and non-transplant surgeries between 2011 and 2024 at a U.S. academic hospital. Researchers meticulously reviewed nursing and physician charts and employed various assessment tools to identify patients who developed delirium within seven days post-surgery. The analysis accounted for patient and procedural factors, including social determinants of health such as socioeconomic status.
Among the 49,588 patients, 4,287 (8.7%) reported speaking a primary language other than English, with Spanish (28.5%) and Cantonese (13.5%) being the most prevalent. Overall, 2,328 (4.7%) developed postoperative delirium — 2,093 whose primary language was English and 235 whose primary language was not English.
Implications of the Findings
Researchers concluded that patients whose primary language was not English were 23% more likely to develop delirium after surgery than their English-speaking counterparts. Moreover, this risk increased by 31% among non-English-speaking patients with lower estimated household incomes.
In cases where patients primarily spoke Spanish or other non-English languages, 151 of the 235 who developed delirium had interpreter support. However, this did not mitigate the risk of delirium.
“Most clinical interactions happen on the wards and in the ICU, where interpreter services aren’t always readily available — especially in the first days after surgery, when most delirium occurs,” explained Dr. Schaefer. “While more research is needed on mechanisms, we suspect that greater confusion and fewer opportunities for verbal reorientation during this early postoperative phase may help explain the elevated delirium risk, even when interpreters are used.”
Addressing the Challenge
It is crucial that the entire healthcare team is made aware of language barriers early in a patient’s perioperative care. This awareness allows for accommodations that go beyond interpreter services. Suggested measures include assigning healthcare providers who speak the patient’s language, ensuring family members are present to assist with verbal reorientation, and conducting pre-admission testing clinics to identify risk factors for delirium.
However, the authors acknowledge that these steps alone are insufficient. Disparities in healthcare access and delivery are structural issues that require broader systemic changes beyond individual patient-level interventions.
The findings from this study underscore the need for healthcare systems to adapt to the linguistic and cultural needs of their patients to improve surgical outcomes and reduce complications like postoperative delirium. As the U.S. population continues to diversify, addressing these challenges becomes increasingly imperative.
The American Society of Anesthesiologists (ASA), founded in 1905, remains committed to advancing the medical practice of anesthesiology. With over 59,000 members, ASA plays a pivotal role in ensuring anesthesiologists oversee the medical care of patients before, during, and after surgery, as well as in critical care and pain management settings.
