Key PointsQuestionIs English language proficiency in adult surgical patients associated with differences in perioperative care and surgical outcomes?FindingsIn this systematic review of 29 studies with 281 266 patients, surgical patients with limited English proficiency experienced reduced access, delays in care, and longer surgical admissions and were more likely to be discharged to a skilled facility than patients with English proficiency. Clinical outcomes related to mortality, postoperative complications, and unplanned readmissions showed fewer significant associations with English proficiency status.MeaningThese findings indicate that limited English proficiency is associated with several perioperative process-of-care outcomes; additional studies are needed to understand the impact of language barriers on perioperative health disparities.