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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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Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet 2023; 401:1531-1544. [PMID: 37023783 DOI: 10.1016/s0140-6736(23)00020-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 04/08/2023]
Abstract
The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Tamatea JAU, Karalus M, Boyle V, Meyer-Rochow GY, Elston MS. Ethnic differences in patients undergoing thyroidectomy for non-toxic multinodular goitre. ANZ J Surg 2023; 93:550-554. [PMID: 36537156 DOI: 10.1111/ans.18181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Māori have an increased incidence of thyrotoxicosis when compvared to non-Māori, however there are limited data on benign non-toxic nodular thyroid disease. AIMS The aims of this study were to determine the rates of non-toxic multinodular goitre (NTMNG) surgery for Māori and non-Māori and to determine if there were differences in thyroid size between Māori and non-Māori undergoing total thyroidectomy for NTMNG. METHODS Single centre study of patients undergoing thyroidectomy for NTMNG from 1 December 2006 to 30 November 2016. RESULTS Māori were overrepresented amongst the 427 patients who underwent surgery for NTMNG at 34% compared to the expected ~17% of the background Māori adult population in the region. At the time of surgery, Māori were younger (P = 0.004) and had a larger thyroid gland (P < 0.001) when compared to non-Maori also undergoing total/near total thyroidectomy. Complication rates were low across all ethnic groups. CONCLUSION Māori have increased rates of surgery for NTMNG compared to non-Māori and thyroid size is larger at the time of surgery. The reasons for this are currently unknown and more research is required.
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Affiliation(s)
- Jade A U Tamatea
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Endocrine Department, Te Whatu Ora Waikato, Hamilton, Waikato, New Zealand
| | - Miriam Karalus
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Veronica Boyle
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Endocrine Department, Te Whatu Ora Waikato, Hamilton, Waikato, New Zealand
| | - Goswin Y Meyer-Rochow
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Department of Surgery, Te Whatu Ora Waikato, Hamilton, Waikato, New Zealand
| | - Marianne S Elston
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
- Endocrine Department, Te Whatu Ora Waikato, Hamilton, Waikato, New Zealand
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Lin JX, Wen D, Sharma A, van der Werf B, Martin RCW, Harman R. Morbidity following thyroid and parathyroid surgery: Results from key performance indicator assessment at a high-volume centre in New Zealand. ANZ J Surg 2021; 91:1804-1812. [PMID: 34405501 DOI: 10.1111/ans.17099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Complications following thyroid/parathyroid surgery include recurrent laryngeal nerve (RLN) injury, hypocalcaemia and return to theatre for haematoma evacuation. Rates of these form the basis of key performance indicators (KPI). An endocrine database, containing results from 1997, was established at the North Shore Hospital in Auckland, New Zealand. We aimed to measure complication rates by procedure (thyroid and parathyroid), explore a temporal change in our unit and compare our results against international literature. METHODS A retrospective review of the database between July 1997 and February 2020 was performed. The results for each KPI were analysed in total and over consecutive time periods. A review of the literature was carried out to find international complication rates for comparison. A cumulative sum (CUSUM) analysis was performed to give visual feedback on performance. RESULTS There were 1062 thyroidectomies and 336 parathyroidectomies from July 1997 to February 2020. Thyroid surgery results found rates of temporary/permanent RLN injury of 1.9%/0.3%, temporary/permanent hypocalcaemia of 22.3/2.5%, and return to theatre for haematoma evacuation of 1.1%. Parathyroid surgery results were, temporary RLN injury of 0.8% (no permanent injury), temporary/permanent hypocalcaemia of 1.7%/0.4%, and return to theatre for haematoma evacuation of 0.3%. CUSUM analysis found KPI results to be comparable with international literature. CONCLUSION Our unit's KPI results are comparable to published results in the literature. The use of this clinical database will help in future monitoring of performance and help drive improvement in the service. Embedding prospective data collection as routine practice allows for continuous improvement for the unit.
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Affiliation(s)
- Jin Xin Lin
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Daniel Wen
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Avinash Sharma
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard C W Martin
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Richard Harman
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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