Key result
Indigenous patients in North America and Oceania experienced significantly higher odds of post-operative morbidity (OR 1.26) compared to non-Indigenous patients.
Why the study?
Data gaps remain regarding global differences in surgical morbidity and mortality for Indigenous populations across geographic locations and surgical specialties.
Do Indigenous patients experience worse post-operative morbidity and mortality compared to non-Indigenous patients following surgical procedures?
Systematic Review (n=9,758,892)
Do Indigenous patients experience worse post-operative morbidity and mortality compared to non-Indigenous patients following surgical procedures?
Odds Ratio: 1.26 (95% CI 1.1–1.44)
p-value: p=<0.01
Indigenous patients in North America and Oceania experience significantly higher rates of post-operative morbidity, infections, and reoperations compared to non-Indigenous patients, highlighting a critical need for targeted interventions to achieve surgical equity.
Highlights the urgent need for targeted perioperative equity initiatives; extends known health disparities.
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.
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Livergant et al. (2023) conducted a systematic review in Post-operative outcomes (n=9,758,892). Indigenous status vs. Non-Indigenous status was evaluated on Post-operative morbidity (OR 1.26, 95% CI 1.10-1.44, p=<0.01). Indigenous patients in North America and Oceania experienced significantly higher odds of post-operative morbidity (OR 1.26) compared to non-Indigenous patients.
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