McVicar, Jason A

Hoang-Nguyen, Jenny

O'Shea, Justine

Champion, Caitlin

Sheffield, Chelsey

Allen, Jean

Kimmaliardjuk, Donna May

Poon, Alana

Bould, M Dylan

Nickerson, Jason W

Caron, Nadine R

McIsaac, Daniel I

2022-05-03

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.

Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC jmcvicar@toh.ca.

Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC.

CMAJ Open. 2022 May 3;10(2):E304-E312. doi: 10.9778/cmajo.20210108. Print 2022 Apr-Jun.

https://pubmed.ncbi.nlm.nih.gov/35504694/?otool=iaurydwlib

https://hdl.handle.net/10137/12173

10

Adult

Canada

Hospital Mortality

Humans

*Inuits

Nunavut/epidemiology

Retrospective Studies

Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study.

Journal Article

Publication