RT Journal Article
SR Electronic
T1 Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E304
OP E312
DO 10.9778/cmajo.20210108
VO 10
IS 2
A1 Jason A. McVicar
A1 Jenny Hoang-Nguyen
A1 Justine O’Shea
A1 Caitlin Champion
A1 Chelsey Sheffield
A1 Jean Allen
A1 Donna May Kimmaliardjuk
A1 Alana Poon
A1 M. Dylan Bould
A1 Jason W. Nickerson
A1 Nadine R. Caron
A1 Daniel I. McIsaac
YR 2022
UL http://www.cmajopen.ca/content/10/2/E304.abstract
AB Background: Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre.Methods: We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs.Results: A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03–1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03–2.58) and elective surgery (OR 1.58, 95% CI 1.20–2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit.Interpretation: Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.