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Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

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 se...

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Autores principales: McVicar, Jason A., Poon, Alana, Caron, Nadine R., Bould, M. Dylan, Nickerson, Jason W., Ahmad, Nora, Kimmaliardjuk, Donna May, Sheffield, Chelsey, Champion, Caitlin, McIsaac, Daniel I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Joule Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177941/
https://www.ncbi.nlm.nih.gov/pubmed/34001549
http://dx.doi.org/10.1503/cmaj.191682
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author McVicar, Jason A.
Poon, Alana
Caron, Nadine R.
Bould, M. Dylan
Nickerson, Jason W.
Ahmad, Nora
Kimmaliardjuk, Donna May
Sheffield, Chelsey
Champion, Caitlin
McIsaac, Daniel I.
author_facet McVicar, Jason A.
Poon, Alana
Caron, Nadine R.
Bould, M. Dylan
Nickerson, Jason W.
Ahmad, Nora
Kimmaliardjuk, Donna May
Sheffield, Chelsey
Champion, Caitlin
McIsaac, Daniel I.
author_sort McVicar, Jason A.
collection PubMed
description 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; I(2) = 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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spelling pubmed-81779412021-06-05 Postoperative outcomes for Indigenous Peoples in Canada: a systematic review McVicar, Jason A. Poon, Alana Caron, Nadine R. Bould, M. Dylan Nickerson, Jason W. Ahmad, Nora Kimmaliardjuk, Donna May Sheffield, Chelsey Champion, Caitlin McIsaac, Daniel I. CMAJ Research 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; I(2) = 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 CMA Joule Inc. 2021-05-17 /pmc/articles/PMC8177941/ /pubmed/34001549 http://dx.doi.org/10.1503/cmaj.191682 Text en © 2021 CMA Joule Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
McVicar, Jason A.
Poon, Alana
Caron, Nadine R.
Bould, M. Dylan
Nickerson, Jason W.
Ahmad, Nora
Kimmaliardjuk, Donna May
Sheffield, Chelsey
Champion, Caitlin
McIsaac, Daniel I.
Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title_full Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title_fullStr Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title_full_unstemmed Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title_short Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
title_sort postoperative outcomes for indigenous peoples in canada: a systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177941/
https://www.ncbi.nlm.nih.gov/pubmed/34001549
http://dx.doi.org/10.1503/cmaj.191682
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