RT Journal Article
SR Electronic
T1 Postoperative outcomes for Indigenous Peoples in Canada: a systematic review
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E713
OP E722
DO 10.1503/cmaj.191682
VO 193
IS 20
A1 McVicar, Jason A.
A1 Poon, Alana
A1 Caron, Nadine R.
A1 Bould, M. Dylan
A1 Nickerson, Jason W.
A1 Ahmad, Nora
A1 Kimmaliardjuk, Donna May
A1 Sheffield, Chelsey
A1 Champion, Caitlin
A1 McIsaac, Daniel I.
YR 2021
UL http://www.cmaj.ca/content/193/20/E713.abstract
AB 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