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Livergant RJ, Stefanyk K, Binda C, Fraulin G, Maleki S, Sibbeston S, Joharifard S, Hillier T, Joos E. Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001805. [PMID: 37585444 PMCID: PMC10431673 DOI: 10.1371/journal.pgph.0001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02-1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.
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Affiliation(s)
- Rachel J. Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kelsey Stefanyk
- Faculty of Medicine, University of British Columbia, Prince George, British Columbia, Canada
| | - Catherine Binda
- Faculty of Medicine, University of British Columbia, Terrace, British Columbia, Canada
| | - Georgia Fraulin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Maleki
- Faculty of Pharmaceutical Sciences, Lower Mainland Pharmacy Services, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Sibbeston
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Northwest Territory Métis Nation, Yellowknife, Northwest Territories, Canada
| | - Shahrzad Joharifard
- Department of Pediatric and Thoracic Surgery, British Columbia Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Tracey Hillier
- Mi’kmaq Qalipu First Nation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Emilie Joos
- Division of General Surgery, Branch for Global Surgical Care, Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Wells CI, Varghese C, Boyle LJ, McGuinness MJ, Keane C, O'Grady G, Gurney J, Koea J, Harmston C, Bissett IP. "Failure to Rescue" following Colorectal Cancer Resection: Variation and Improvements in a National Study of Postoperative Mortality. Ann Surg 2023; 278:87-95. [PMID: 35920564 DOI: 10.1097/sla.0000000000005650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To examine variation in "failure to rescue" (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. BACKGROUND Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. METHODS A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. RESULTS Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8-3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5-2.8), and postoperative complications (OR 1.4, 95% CI 1.3-1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4-0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4-0.7) than complications (OR 0.8, 95% CI 0.8-0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery. CONCLUSION Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in "rescue" from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of "rescue" as a target for surgical quality improvement.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Luke J Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | | | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Chris Harmston
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Northland District Health Board, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Ingram MC, Becker S, Olson SL, Tsai S, Sarkar A, Rothstein DH, Skarsgard ED, Raval MV. Disparities in surgical health service delivery and outcomes for indigenous children. J Pediatr Surg 2023; 58:375-383. [PMID: 36241445 DOI: 10.1016/j.jpedsurg.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence of health disparities for Indigenous children requiring surgical care is lacking. We present a systematic review of the literature examining possible disparities in surgical care and outcomes for pediatric patients of Indigenous ethnicity. DATA SOURCES PubMed, Cochrane, MEDLINE, gray literature. METHODS Literature review, using PubMed, Cochrane, MEDLINE, and gray literature was conducted to identify articles published more than 2010-2020 examining children's surgical health service delivery (epidemiology, access, operations provided) and outcomes for pediatric patients of Indigenous ethnicity compared with others. Extracted data included study design, setting, participant race/ethnicity, operations examined, and surgical outcomes. Article quality was assessed using the Newcastle-Ottawa Scales. RESULTS From 411 abstracts, 125 articles were reviewed and 33 included for data abstraction. These were cohort and cross-sectional studies investigating a wide range of patient populations and procedures across the United States, Canada, Australia, and New Zealand. Articles were organized naturally by theme into birth malformations (15 articles), trauma (6 articles), pediatric general surgery/appendicitis (5 articles), pediatric otolaryngology (6 articles), and renal transplant (1 article) surgery. Four articles also described access and resource utilization related to inpatient care. Notable disparities observed included apparent increased prevalence of gastroschisis, rates of traumatic fatality, non accidental injury, and self harm among North American Indigenous children. CONCLUSIONS Indigenous children appear to be vulnerable to a number of health and treatment outcome disparities related to conditions treated by surgeons. Surgeons are thus uniquely poised to act in identifying and eliminating Indigenous ethnicity-based pediatric health disparities.
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Affiliation(s)
- Martha-Conley Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
| | - Sasha Becker
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sydney L Olson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Stacy Tsai
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Arjun Sarkar
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - David H Rothstein
- Division of Pediatric Surgery, Department of Surgery, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Livergant RJ, Fraulin G, Stefanyk K, Binda C, Maleki S, Joharifard S, Hillier T, Joos E. Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis. Pediatr Surg Int 2023; 39:129. [PMID: 36795335 PMCID: PMC9935719 DOI: 10.1007/s00383-023-05377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Mounting evidence suggests that childhood health is an important predictor of wellness as an adult. Indigenous peoples worldwide suffer worse health outcomes compared to settler populations. No study comprehensively evaluates surgical outcomes for Indigenous pediatric patients. This review evaluates inequities between Indigenous and non-Indigenous children globally for postoperative complications, morbidities, and mortality. Nine databases were searched for relevant subject headings including "pediatric", "Indigenous", "postoperative", "complications", and related terms. Main outcomes included postoperative complications, mortality, reoperations, and hospital readmission. A random-effects model was used for statistical analysis. The Newcastle Ottawa Scale was used for quality assessment. Fourteen studies were included in this review, and 12 met inclusion criteria for meta-analysis, representing 4793 Indigenous and 83,592 non-Indigenous patients. Indigenous pediatric patients had a greater than twofold overall (OR 2.0.6, 95% CI 1.23-3.46) and 30-day postoperative mortality (OR 2.23, 95% CI 1.23-4.05) than non-Indigenous populations. Surgical site infections (OR 1.05, 95% CI 0.73-1.50), reoperations (OR 0.75, 95% CI 0.51-1.11), and length of hospital stay (SMD = 0.55, 95% CI - 0.55-1.65) were similar between the two groups. There was a non-significant increase in hospital readmissions (OR 6.09, 95% CI 0.32-116.41, p = 0.23) and overall morbidity (OR 1.13, 95% CI 0.91-1.40) for Indigenous children. Indigenous children worldwide experience increased postoperative mortality. It is necessary to collaborate with Indigenous communities to promote solutions for more equitable and culturally appropriate pediatric surgical care.
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Affiliation(s)
- Rachel J Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Georgia Fraulin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kelsey Stefanyk
- Faculty of Medicine, University of British Columbia, Prince George, BC, Canada
| | - Catherine Binda
- Faculty of Medicine, University of British Columbia, Terrace, BC, Canada
| | - Sasha Maleki
- Lower Mainland Pharmacy Services, Vancouver General Hospital, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahrzad Joharifard
- Department of Pediatric and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Tracey Hillier
- Mi'kmaq Qalipu First Nation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Emilie Joos
- Division of General Surgery, Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, 767 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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McVicar JA, Hoang-Nguyen J, O'Shea J, Champion C, Sheffield C, Allen J, Kimmaliardjuk DM, Poon A, Bould MD, Nickerson JW, Caron NR, McIsaac DI. Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study. CMAJ Open 2022; 10:E304-E312. [PMID: 35504694 PMCID: PMC9259461 DOI: 10.9778/cmajo.20210108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre. METHODS We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs. RESULTS A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03-1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03-2.58) and elective surgery (OR 1.58, 95% CI 1.20-2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit. INTERPRETATION Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.
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Affiliation(s)
- Jason A McVicar
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jenny Hoang-Nguyen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Justine O'Shea
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Caitlin Champion
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Chelsey Sheffield
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jean Allen
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Donna May Kimmaliardjuk
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Alana Poon
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Jason W Nickerson
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Nadine R Caron
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Issues postopératoires chez les Autochtones au Canada: revue systématique. CMAJ 2021; 193:E1310-E1321. [PMID: 34426452 PMCID: PMC8412424 DOI: 10.1503/cmaj.191682-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
Contexte: Il existe d’importantes iniquités en matière de santé chez les populations autochtones au Canada. La faible densité de la population canadienne et les populations en région éloignée posent un problème particulier à l’accès et à l’utilisation des soins chirurgicaux. Aucune synthèse des données sur les issues chirurgicales chez les Autochtones au Canada n’avait été publiée jusqu’à maintenant. Méthodes: Nous avons interrogé 4 bases de données pour recenser les études comparant les issues chirurgicales et les taux d’utilisation chez les adultes des Premières Nations, inuits et métis et chez les adultes non autochtones au Canada. Des évaluateurs indépendants ont réalisé toutes les étapes en parallèle. L’issue primaire était la mortalité; les issues secondaires comprenaient le taux d’utilisation des chirurgies, les complications et la durée du séjour à l’hôpital. Nous avons effectué une méta-analyse pour l’issue primaire à l’aide d’un modèle à effets aléatoires. Nous avons évalué les risques de biais à l’aide de l’outil ROBINS-I. Résultats: Vingt-huit études ont été analysées, pour un total de 1 976 258 participants (10,2 % d’Autochtones). Aucune étude ne portait précisément sur les populations inuites et métisses. Quatre études portant sur 7 cohortes ont fourni des données corrigées sur la mortalité pour 7135 participants (5,2 % d’Autochtones); les Autochtones présentaient un risque de décès après une intervention chirurgicale 30 % plus élevé que les patients non autochtones (rapport de risque combiné 1,30; IC à 95 % 1,09–1,54; I2 = 81 %). Les complications étaient aussi plus fréquentes chez le premier groupe, notamment les infections (RC corrigé 1,63; IC à 95 % 1,13–2,34) et les pneumonies (RC 2,24; IC à 95 % 1,58–3,19). Les taux de différentes interventions chirurgicales étaient plus faibles, notamment pour les transplantations rénales, les arthroplasties, les chirurgies cardiaques et les accouchements par césarienne. Interprétation: Les données disponibles sur les issues postopératoires et le taux d’utilisation de la chirurgie chez les Autochtones au Canada sont limitées et de faible qualité. Elles suggèrent que les Autochtones ont de plus hauts taux de décès et d’issues négatives postchirurgicales et qu’ils font face à des obstacles dans l’accès aux interventions chirurgicales. Ces conclusions indiquent qu’il y a un besoin de réévaluer en profondeur les soins chirurgicaux prodigués aux Autochtones au Canada pour leur assurer un accès équitable et améliorer les issues. Numéro d’enregistrement du protocole: PROSPERO-CRD42018098757.
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Affiliation(s)
- Jason A McVicar
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont.
| | - Alana Poon
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nadine R Caron
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - M Dylan Bould
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Jason W Nickerson
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Nora Ahmad
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Chelsey Sheffield
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Caitlin Champion
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
| | - Daniel I McIsaac
- Départements d'anesthésiologie et de médecine de la douleur (McVicar, Poon, Bould, McIsaac) et de chirurgie (Kimmaliardjuk), Faculté de médecine (Ahmad, pendant l'étude); Centre de droit, politique et éthique de la santé (Nickerson), Université d'Ottawa; L'Hôpital d'Ottawa (McVicar, Poon, Kimmaliardjuk, McIsaac); Centre hospitalier pour enfants de l'est de l'Ontario (Bould); Institut de recherche Bruyère (Nickerson), Ottawa, Ont.; Département de chirurgie et Programme de médecine en région nordique (Caron), Université de la Colombie-Britannique, Prince George, C.-B.; Centre d'excellence en santé autochtone (Caron), Université de la Colombie-Britannique, Vancouver, C.-B.; Département d'anesthésiologie et de médecine de la douleur (Ahmad, au moment de la rédaction), Université de Toronto, Toronto, Ont.; Hôpital général Qikiqtani (Sheffield), Iqaluit (Nunavut); Centre de santé West Parry Sound (Champion), Parry Sound, Ont.; Département de chirurgie (Champion), École de médecine du Nord de l'Ontario, Sudbury, Ont
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Wan N, McCrum M, Han J, Lizotte S, Su D, Wen M, Zeng S. Measuring spatial access to emergency general surgery services: does the method matter? HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021. [DOI: 10.1007/s10742-021-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McVicar JA, Poon A, Caron NR, Bould MD, Nickerson JW, Ahmad N, Kimmaliardjuk DM, Sheffield C, Champion C, McIsaac DI. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021; 193:E713-E722. [PMID: 34001549 PMCID: PMC8177941 DOI: 10.1503/cmaj.191682] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. Protocol registration: PROSPERO-CRD42018098757
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Affiliation(s)
- Jason A McVicar
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Alana Poon
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Nadine R Caron
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - M Dylan Bould
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Jason W Nickerson
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
| | - Nora Ahmad
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Donna May Kimmaliardjuk
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Chelsey Sheffield
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Caitlin Champion
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
| | - Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC; Department of Anesthesiology and Pain Medicine (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont
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O'Brien P, Bunzli S, Lin I, Bessarab D, Coffin J, Dowsey MM, Choong PFM. Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action. ANZ J Surg 2021; 91:238-244. [PMID: 33506978 DOI: 10.1111/ans.16557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
Aboriginal and Torres Strait Islander people continue to experience health inequity within the Australian health care system. Little research has examined how disparities in surgical care access and outcomes contribute to Aboriginal health. In this narrative review and call to action, we discuss five care points along the journey to high-quality surgical care: health care seeking, primary health care services, specialist services, surgery and surgical outcomes. We highlight barriers and disparities that exist along this journey, drawing examples from the field of joint replacement surgery. Finally, we present opportunities for change at the health system, health service and clinician level, calling upon researchers, clinicians and policy makers to confront the surgical disparities experienced by Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Penny O'Brien
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Juli Coffin
- Social and Emotional Wellbeing of Aboriginal Young People, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Michelle M Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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