Language barriers linked to worse gynecologic surgery pain management


A study highlighted how non-English-speaking patients undergoing gynecologic surgery face undertreated pain, emphasizing the need for equitable pain management practices.

Language barriers linked to worse gynecologic surgery pain management | Image Credit: © steheap - © steheap -

Language barriers linked to worse gynecologic surgery pain management | Image Credit: © steheap - © steheap -

The risk of undertreated pain in the postoperative setting in gynecologic surgery is increased among patients who do not speak English, according to a recent study in AJOG Global Reports.


  1. Non-English-speaking patients in gynecologic surgery settings are at risk of undertreated postoperative pain, as highlighted in a recent study.
  2. Racial and ethnic disparities exist in postoperative pain management, with historically underrepresented patients receiving fewer pain medications than their White counterparts.
  3. Language barriers impact pain management, with non-English-speaking patients receiving fewer pain assessments and opioid medications compared to English-speaking patients.
  4. Despite similar intraoperative opioid administration, non-English-speaking patients receive fewer opioid units per day and at discharge, indicating disparities in pain relief strategies.
  5. The findings underscore the importance of evidence-based, equitable pain management practices in gynecologic oncology to ensure optimal postoperative outcomes for all patients.

Recovery and quality of life are significantly impacted by postoperative pain. Increased pain is associated with increased rates of complications, longer hospital stays, increased costs, higher readmission rates, and prolonged opioid use.

Data has indicated racial and ethnic disparities in postoperative pain management, with historically underrepresented patients receiving few pain medications than their White counterparts. However, there is little information about the impact of language on postoperative pain management.

To assess the association between language and postoperative pain management among English-speaking (ES) and non-English-speaking (NES) patients, investigators conducted a retrospective cohort study. Patients’ preferred language was determined through data in their electronic medical records (EMRs).

Participants included patients aged 18 years and older with an open surgery performed by a gynecologic oncologist between July 1, 2012, to December 31, 2020. Exclusion criteria included being pregnant during the surgery and not being primarily treated by a gynecologic oncology service.

Opioid use was reported as oral morphine equivalents (OMEs), with intraoperative OME data obtained from anesthesia documentation and daily OME data from the Medication Administration Record. EMRs were evaluated for data about the frequency and type of pain assessment.

Patients often rated their pain on a scale from 0 to 10. Otherwise, pain would be determined through a behavioral scale. Covariates included age, depression, and hysterectomy rates.

There were 1199 patients included in the final analysis, 15.1% of whom were NES patients and 84.9% were ES patients. Of NES patients, 54.7% were Hispanic. In comparison, 65.3% of ES patients were White.

Body mass index, preoperative opioid use, American Society of Anesthesiologists score, and alcohol use did not differ between cohorts. However, NES patients were younger and had decreased tobacco use, anxiety, depression, and chronic pain.

Intraoperative OME administration and postoperative opioid-sparing modality use did not differ between cohorts. However, less OMEs per day were reported among NES patients vs ES patients, at 31.7 OMEs vs 43.9 OMEs, respectively. Additionally, the odds of receiving larger prescription sizes were greater among ES patients than NES patients.

For pain assessment, NES patients only received 7.7 checks per day, vs 8.8 checks per day among ES patients. The median pain scores in these groups were 2 out of 10 and 3 out of 10, respectively. Both groups were assessed using verbal pain scores.

In the hospital, ES patients received an additional 19.5 OMEs per day than NES patients. This group also received 205.1 more OME units in the discharge prescription. Few OMEs were also given to Asian and Black patients vs their White counterparts.

These results indicated poorer postoperative pain management among NES patients vs ES patients. Investigators concluded an evidence-based, equitable practice is necessary to manage pain among gynecologic oncology patients.


Levy RA, Kay AH, Hills N, Chen LM, Chapman JS. Exploring the relationship between language, postoperative pain, and opioid use. AJOG Glob Rep. 2024;4(2):100342. doi:10.1016/j.xagr.2024.100342.

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