Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis
Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geogra...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10431673/?tool=EBI |
| _version_ | 1797697958247923712 |
|---|---|
| author | Rachel J. Livergant Kelsey Stefanyk Catherine Binda Georgia Fraulin Sasha Maleki Sarah Sibbeston Shahrzad Joharifard Tracey Hillier Emilie Joos |
| author_facet | Rachel J. Livergant Kelsey Stefanyk Catherine Binda Georgia Fraulin Sasha Maleki Sarah Sibbeston Shahrzad Joharifard Tracey Hillier Emilie Joos |
| author_sort | Rachel J. Livergant |
| collection | DOAJ |
| description | Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10–1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12–1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02–1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations. |
| first_indexed | 2024-03-12T03:47:19Z |
| format | Article |
| id | doaj.art-440a44b09c1840699b10c5cbaa7b2210 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:47:19Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-440a44b09c1840699b10c5cbaa7b22102023-09-03T12:42:43ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0138Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysisRachel J. LivergantKelsey StefanykCatherine BindaGeorgia FraulinSasha MalekiSarah SibbestonShahrzad JoharifardTracey HillierEmilie JoosIndigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10–1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12–1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02–1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10431673/?tool=EBI |
| spellingShingle | Rachel J. Livergant Kelsey Stefanyk Catherine Binda Georgia Fraulin Sasha Maleki Sarah Sibbeston Shahrzad Joharifard Tracey Hillier Emilie Joos Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis PLOS Global Public Health |
| title | Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis |
| title_full | Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis |
| title_fullStr | Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis |
| title_full_unstemmed | Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis |
| title_short | Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis |
| title_sort | post operative outcomes in indigenous patients in north america and oceania a systematic review and meta analysis |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10431673/?tool=EBI |
| work_keys_str_mv | AT racheljlivergant postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT kelseystefanyk postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT catherinebinda postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT georgiafraulin postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT sashamaleki postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT sarahsibbeston postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT shahrzadjoharifard postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT traceyhillier postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis AT emiliejoos postoperativeoutcomesinindigenouspatientsinnorthamericaandoceaniaasystematicreviewandmetaanalysis |