Key result
Nunavut Inuit patients had a 25% relative increase in the odds of in-hospital morbidity and death after surgery compared with non-Inuit patients (adjusted OR 1.25).
Why the study?
Limited access to specialized surgical and perioperative care can negatively affect patient outcomes, prompting a comparison of postoperative outcomes between Nunavut Inuit and non-Inuit patients.
Does Nunavut Inuit ethnicity increase the risk of in-hospital death or complications following inpatient surgery compared to non-Inuit patients?
Cohort (n=98,701)
No
Does Nunavut Inuit ethnicity increase the risk of in-hospital death or complications following inpatient surgery compared to non-Inuit patients?
Effect estimate: OR 1.25 (95% CI 1.03-1.51)
Absolute Event Rate: 17.2% vs 16.1%
Nunavut Inuit patients face a 25% relative increase in the odds of postoperative morbidity and mortality compared to non-Inuit patients at a major Canadian quaternary care hospital.
May warrant closer perioperative monitoring for Nunavut Inuit patients; leaves open causal pathways and mitigation strategies.
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.
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McVicar et al. (2022) conducted a cohort in Inpatient surgery (n=98,701). Nunavut Inuit identity vs. Non-Inuit patients was evaluated on Composite of in-hospital death or complications (OR 1.25, 95% CI 1.03-1.51). Nunavut Inuit patients had a 25% relative increase in the odds of in-hospital morbidity and death after surgery compared with non-Inuit patients (adjusted OR 1.25).
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