Impact of Limited English Proficiency on Perioperative Care with a Focus on Spanish-Speaking Populations

Background Hispanic and Latino populations now comprise approximately 20% of the U.S. population, and Spanish is the most common non-English language spoken in the United States. Among Spanish-speaking individuals, 39% report limited English proficiency (LEP), defined as a limited ability to communicate in English at a level that permits effective interaction with healthcare providers. Despite federal mandates requiring language access in healthcare settings, adherence to these standards remains inconsistent. Surgical care presents unique communication challenges given the complexity of informed consent, perioperative risk counseling, and postoperative instructions. This review examines the impact of language barriers across the perioperative continuum in LEP surgical patients, with particular attention to Spanish-speaking populations. Methods A structured literature review was conducted using PubMed. Search terms included combinations of: “limited English proficiency,” “language barrier,” “Spanish-speaking,” “interpreter services,” “surgery,” “perioperative,” “postoperative,” “complications,” “readmission,” and “length of stay.” Studies were included if they examined surgical patients with LEP or Spanish-speaking populations and reported measurable perioperative or postoperative outcomes, published in peer-reviewed English-language journals. Editorials, case reports, and studies focused exclusively on non-surgical care were excluded. Data were organized thematically and analyzed via qualitative synthesis. Results Thirty-four studies met inclusion criteria. LEP patients face barriers across the entire perioperative continuum. They are more likely to present for emergent rather than elective surgery and experience longer wait times for transplant and surgical evaluation. Informed consent documentation was consistently incomplete for LEP patients, with frequent use of ad hoc interpretation by family members, including bilingual minors. Interpreter utilization was associated with shorter length of stay and improved pain management, though documentation of interpreter use was inconsistent. LEP patients received less frequent pain assessments, experienced longer wait times for analgesia, and had higher rates of urgent readmission. Postoperative complications including venous thromboembolism and pneumonia were elevated in some surgical specialties, though findings were mixed across studies. LEP patients also demonstrated significantly lower use of patient portals and telemedicine during follow-up. Language-concordant care and language-serving institutions were associated with improved outcomes, including lower readmission rates. Conclusions Language barriers represent a modifiable risk factor throughout the surgical care continuum. While interpreter services improve perioperative outcomes, they do not fully eliminate disparities. Language-concordant care, standardized interpreter training, and institutional policies that prioritize linguistically appropriate communication are essential to achieving equitable surgical care for LEP patients. Language discordance should be recognized as a patient safety concern rather than solely a cultural consideration. Future research should prioritize prospective, multi-institutional studies with standardized LEP definitions and greater evaluation of language-concordant surgical care across diverse linguistic communities.