Postoperative Mortality of Indigenous Populations Compared With Nonindigenous Populations

Abstract

IMPORTANCEA range of factors have been identified as possible contributors to racial/ethnic differences in postoperative mortality that are also likely to hold true for indigenous populations. Yet despite its severity as an outcome, death in the period following a surgical procedure is underresearched for indigenous populations.OBJECTIVE To describe postoperative mortality experiences for minority indigenous populations compared with numerically dominant nonindigenous populations and examine the factors that drive any differences observed.EVIDENCE REVIEW This review was conducted according to PRIMSA guidelines and registered on PROSPERO. Articles were identified through searches of the Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, with manual review of references and gray literature searches conducted. Eligible articles included those that reported associations between ethnicity/indigeneity and mortality up to 90 days following surgery and published in English between January 1, 1990, and March 26, 2019. Data on the study design, setting, participants (including indigeneity), and results were extracted. A modified Newcastle-Ottawa Quality Assessment Scale was used to determine study quality.FINDINGS A total of 442 abstracts were screened, 92 articles were reviewed in full text, and 21 articles (from 20 studies) and 7 reports underwent data extraction. All included studies were cohort studies (3 prospective and the remainder retrospective) investigating a wide range of surgical procedures in the US, Australia, or New Zealand. Seven studies were from single facilities, while the remainder used data from national databases. Sample sizes ranged, with indigenous sample sizes ranging from 20 to 3052 patients and a number of studies reporting less than 10 indigenous deaths. The postoperative mortality experience for minority indigenous populations compared with the nonindigenous populations was mixed. There was evidence from several studies that indigenous populations may be more likely to die following cardiac procedures. However, the available evidence has overall poor study quality, with methods to identify the indigenous populations being a major limitation of most of the studies. CONCLUSIONS AND RELEVANCEPostoperative mortality experiences for indigenous populations should not be interpreted in isolation from the broader context of inequities across the health care pathway and must take into account the quality of data used for indigenous identification.

Postoperative outcomes for Indigenous Peoples in Canada: a systematic review

“…Our findings are consistent with inequities in surgical outcomes for Indigenous Peoples observed in other high income countries. [48][49][50][51] Although part of this effect may be attributable to the burden of chronic disease in Indigenous populations, our findings emerged by pooling results from studies that adjusted for important confounders, such as comorbidity status, which suggests that other factors may contribute.…”

Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action

“…Aboriginal people that undergo surgical treatment, are younger, present at more advanced stages of disease and experience higher rates of post‐operative morbidity and mortality 5,6,40,62,63 . These poor health outcomes can reinforce distrust in clinicians and services and further hamper a willingness to seek health care.…”

“…The majority of literature exploring disparities in surgical outcomes come from the field of cardiac surgery 62,64,66,67 and there is a lack of studies investigating disparities other surgical specialties. In a recent systematic review exploring post‐operative mortality in Indigenous populations, seven Australian studies were identified all of which addressed cardiac procedures 6 . There is an urgent need for a better understanding of outcomes for Aboriginal people in all surgical specialties, to identify whether such disparities exist, and if so, how these may be mitigated to allow more effective and efficient deployment of surgery in Aboriginal communities.…”

“…Often Aboriginal people experience systematic barriers to accessing appropriate, affordable and high‐quality health care including elective surgery 3,4 . With the exception of more recent work, 5,6 little research has examined disparities in surgical care and outcomes that Aboriginal patients experience. Timely access to equitable, high‐quality surgical care is an integral component of Australia's universal health care system 7 .…”

Issues postopératoires chez les Autochtones au Canada: revue systématique

“…Hétérogénéité : I 2 = 81 %, τ 2 = 0,0357, p < 0,01 Bresee et al 22 Leslie et al (poignet) 28 Leslie et al (colonne) 28 Leslie et al (hanche) 28 Goulet et al 26 Hong et al 27 Weber et al 43 Les conclusions concordent avec les iniquités dans les issues chirurgicales observées chez les Autochtones dans d'autres pays à revenu élevé [48][49][50][51] . Bien qu'une partie de cet effet puisse être attribuable au fardeau des maladies chroniques dans ces popula tions, nos conclusions portaient sur la combinaison de résultats corrigés pour les principaux facteurs confondants, comme les comorbidités, ce qui laisse croire que d'autres facteurs con tribueraient à la situation.…”