Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

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. 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).

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

“…Care inequity among marginalized groups is prevalent. [18][19][20][21] As a patient, having a physician with similar experiences has a significant impact on the provision of care. In Plastic, Reconstructive, and Aesthetic surgery, we have the advantage of drawing from a broad palette of care opportunities with a wide array of anatomic domains, that provide a unique and privileged perspective.…”

Improving preventive screening with Indigenous peoples

“…Across Canada, Indigenous peoples have poorer health 2 than non-Indigenous populations, as shown by data on chronic health conditions, avoidable mortality, suicide, substance abuse, and smoking rates 3,4 ; this leads to Indigenous peoples having a shorter life expectancy at birth -by 5 to 11 years-than the rest of the Canadian population. 5,6 Indigenous peoples suffer from persistent inequity of access to care and heavier burden of preventable disease. In a recent publication documenting the association between Indigenous identity and poor postoperative survival, 6 the authors raised questions about differences in disease stage at initial presentation and referral patterns.…”

“…5,6 Indigenous peoples suffer from persistent inequity of access to care and heavier burden of preventable disease. In a recent publication documenting the association between Indigenous identity and poor postoperative survival, 6 the authors raised questions about differences in disease stage at initial presentation and referral patterns.…”

Améliorer le dépistage chez les patients autochtones

“…La santé des peuples autochtones du Canada est moins bonne 2 que celle des allochtones, comme le montrent les données sur les maladies chroniques, la mortalité évitable, le suicide, la toxicomanie et le taux de tabagisme 3,4 ; cela a comme conséquence de raccourcir de 5 à 11 ans l'espérance de vie à la naissance des Autochtones par rapport au reste des Canadiens 5,6 . Les Autochtones subissent des iniquités persistantes en matière d'accès aux soins et le fardeau des maladies chroniques est alourdi au sein d'une majorité des communautés des Premières Nations, métisses et inuit à l'échelle du pays.…”

“…Les Autochtones subissent des iniquités persistantes en matière d'accès aux soins et le fardeau des maladies chroniques est alourdi au sein d'une majorité des communautés des Premières Nations, métisses et inuit à l'échelle du pays. Récemment encore, une revue systématique a mis en lumière le lien entre le statut autochtone et une piètre survie postopératoire 6 , soulevant du même coup des questions sur les enjeux en lien avec les retards de consultation et la référence des patients vers des soins avancés.…”