Post-Operative Complications in Aboriginal and Torres Strait Islander People Undergoing Cardiac Surgery – A Scoping Review

Background Aboriginal and Torres Strait Islander people experience significant perioperative health inequity with respect to cardiac surgery. While post-operative outcomes have been summarised in those undergoing coronary artery bypass grafting (CABG), perioperative cardiac surgical outcomes for Aboriginal and Torres Strait Islander people have not. Methods A literature review was conducted using MEDLINE, Scopus and Embase databases to identify published data comparing post-operative complications in Aboriginal and Torres Strait Islander adults and non-Indigenous Australians undergoing cardiac surgery. Selected search terms were used to identify abstracts from eligible studies, which were then screened to identify relevant articles. Results We identified 15 observational studies examining post-operative complications in Aboriginal and Torres Strait Islander people undergoing cardiac surgery. Seven focused on isolated CABG, two on isolated valve surgery, and the remainder examined a combination of both. These studies revealed higher post-operative complication rates including myocardial infarction, kidney failure and long-term mortality amongst Aboriginal and Torres Strait Islander people compared to their (frequently >10 years) older non-Indigenous Australian counterparts. Post-CABG, this was largely driven by greater preoperative comorbidity (including higher rates of diabetes mellitus and chronic kidney disease). No studies evaluated pre-operative socioeconomic status, frailty or malnutrition, post-operative self-discharge rates or sepsis, or adjusted analyses of outcomes post-valve surgery. No interventional studies were identified. Conclusions Aboriginal and Torres Strait Islander people experience greater post-operative morbidity and mortality post-cardiac surgery than non-Indigenous Australians. However, further research is warranted to explore several clinically relevant pre-operative variables and post-operative complications, and potential interventions to reduce perioperative inequity in this setting.