Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study
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 outc...
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ftpubmed:oai:pubmedcentral.nih.gov:9259461 2023-05-15T16:54:06+02:00 Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study 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 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259461/ http://www.ncbi.nlm.nih.gov/pubmed/35504694 https://doi.org/10.9778/cmajo.20210108 en eng CMA Impact Inc. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259461/ http://www.ncbi.nlm.nih.gov/pubmed/35504694 http://dx.doi.org/10.9778/cmajo.20210108 © 2022 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ CC-BY-NC-ND CC-BY-NC CMAJ Open Research Text 2022 ftpubmed https://doi.org/10.9778/cmajo.20210108 2022-07-31T00:58:34Z 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 ... Text inuit Nunavut Qikiqtaaluk PubMed Central (PMC) Canada Nunavut CMAJ Open 10 2 E304 E312 |
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Research 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. Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
topic_facet |
Research |
description |
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 ... |
format |
Text |
author |
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. |
author_facet |
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. |
author_sort |
McVicar, Jason A. |
title |
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
title_short |
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
title_full |
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
title_fullStr |
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
title_full_unstemmed |
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study |
title_sort |
postoperative outcomes for nunavut inuit at a canadian quaternary care centre: a retrospective cohort study |
publisher |
CMA Impact Inc. |
publishDate |
2022 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259461/ http://www.ncbi.nlm.nih.gov/pubmed/35504694 https://doi.org/10.9778/cmajo.20210108 |
geographic |
Canada Nunavut |
geographic_facet |
Canada Nunavut |
genre |
inuit Nunavut Qikiqtaaluk |
genre_facet |
inuit Nunavut Qikiqtaaluk |
op_source |
CMAJ Open |
op_relation |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259461/ http://www.ncbi.nlm.nih.gov/pubmed/35504694 http://dx.doi.org/10.9778/cmajo.20210108 |
op_rights |
© 2022 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
op_rightsnorm |
CC-BY-NC-ND CC-BY-NC |
op_doi |
https://doi.org/10.9778/cmajo.20210108 |
container_title |
CMAJ Open |
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10 |
container_issue |
2 |
container_start_page |
E304 |
op_container_end_page |
E312 |
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1766044730606485504 |