Incidence, Secular Trends and Outcomes of Cardiac Surgery in Aboriginal Peoples

Sood, Michael; Tangri, Navdeep; Komenda, Paul; Rigatto, Claudio; Khojah, S.; Hiebert, Brett; Menkis, Alan H.; Tam, J.; Arora, R.C.

doi:10.1016/j.cjca.2013.07.357

Cited by 3 publications

(12 citation statements)

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“…We identified 707 titles and abstracts, reviewed 118 full-text articles and included 28 studies (Figure 1, Table 1) published in English from 1989 to 2016. Surgical specialties included urologic (n = 8, 29%), 25,34,[40][41][42][43]45,46 obstetric (n = 5, 18%), 29,33,35,38 orthopedic (n = 3, 11%), 21,28,30,32 general (n = 3, 11%), 24,27,47 cardiac (n = 3, 11%), 22,39,44 ophthalmologic (n = 1, 4%), plastic (n = 1, 4%) and vascular (n = 1, 4%) surgery. 23,26,37 Three studies (11%) included a mix of surgical specialties.…”

Section: Resultsmentioning

confidence: 99%

“…After cardiac surgery, we found higher adjusted rates of infectious complications among First Nations Peoples (infection-adjusted OR 1.63, 95% CI 1.13-2.34; pneumonia OR 2.24, 95% CI 1.58-3.19); a composite of major cardiac and renal events did not differ. 39 Living kidney donors who were First Nations or Métis had higher rates of longterm complications, such as new hypertension (adjusted OR 6.3, 95% CI 1.8-22.1), and diabetes (19.4% v. 1.6%, p = 0.005). 40 Kidney transplant recipients (HR 1.53, 95% CI 1.20-1.95) were more likely to experience graft failure.…”

Section: Discussionmentioning

confidence: 96%

“…Eight studies reported mortality rates (Table 2), 22,23,[26][27][28]39,43,47 including 4 studies that reported crude mortality data. 22,23,26,47 Overall, 47 (16.1%) of 292 people of Indigenous identity died, compared with 1209 (21.4%) of 5647 people of non-Indigenous identity; however, inadequate description of unadjusted data precluded meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…One study reported increased mortality for the Indigenous cohort using adjusted ORs (OR 1.15, 95% CI 0.63-2.08), but the trend was not statistically significant. 39 We explored possible sources of heterogeneity in our pooled effect by surgery type (orthopedic, transplant and cardiovascular). The percentage of variation attributed to heterogeneity across studies was 0% for orthopedic and cardiovascular surgeries and 89% for transplant surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…24 We assessed quality of life after diabetic limb amputation and noted no difference between patients of First Nations or Métis identity and the rest of the study participants (decreased in both groups). 32 Citations from electronic search n = 1106 Twenty studies compared rates of surgery and wait times for Indigenous and non-Indigenous populations [20][21][22][23]25,[29][30][31][33][34][35][36][37][38][39]41,42,[44][45][46] (Appendix 5, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.191682/tab-related-content). Six studies evaluating rates of renal transplantation found that Indigenous Peoples with endstage renal disease were less likely to receive a transplant (HR 0.34-0.54).…”

Section: Discussionmentioning

confidence: 99%

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Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

McVicar

Poon

Caron

et al. 2021

CMAJ

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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. Independ ent 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,). Rates of various sur gical 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 Indigen ous 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 Disclaimer: Three of the authors identify as Indigenous: Jason McVicar (Métis), Nadine Caron (First Nations) and Donna May Kimmiliardjuk (Inuk).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

McVicar

Poon

Caron

et al. 2021

CMAJ

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Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review

et al. 2022

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Issues postopératoires chez les Autochtones au Canada: revue systématique

McVicar

Poon

Caron

et al. 2021

CMAJ

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accès sûr, rapide et abordable aux soins chirurgicaux est essentiel à la santé générale de la population; les pro blèmes de santé pouvant mener à des soins chirurgicaux forment le tiers du fardeau mondial des maladies 1,2 . En plus de représenter 65 % des traitements contre le cancer, les interven tions chirurgicales sont essentielles à la prise en charge des trau mas, et l'accouchement par césarienne peut réduire le taux de mortalité néonatale de 70 % 1 . L'ampleur et l'omniprésence des problèmes nécessitant une intervention chirurgicale font en sorte qu'il est essentiel de surveiller leur prévalence et leur traitement par des systèmes locaux et nationaux afin d'obtenir un portrait exact de la santé et du bienêtre des populations au Canada, ce qui inclut les populations autochtones.Au Canada, il y a environ 1,67 million d'Autochtones, ce qui représente 4,9 % de la population totale (58 % sont des membres des Premières Nations, 4 %, des Inuits et 35 %, des Métis) 3 . Il existe des iniquités en matière de santé chez les Autochtones : leur espérance de vie à la naissance est 5-11 ans plus courte que celle des nonAutochtones 4,5 , et des données montrent clairement qu'on retrouve chez ces populations des taux plus importants de RECHERCHESERVICES DE SANTÉ

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Incidence, Secular Trends and Outcomes of Cardiac Surgery in Aboriginal Peoples

Cited by 3 publications

References 0 publications

Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

Access to Cardiovascular Care for Indigenous Peoples in Canada: A Rapid Review

Issues postopératoires chez les Autochtones au Canada: revue systématique

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