November 4, 2024Canadian Journal of Anesthesia/Journal canadien d anesthésie1 citationsOpen Access

Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study

MCMax Chen KDKaitlin Duncan RTRobert Talarico

Structured PICO

Does Northern Ontario residency increase 30-day mortality and affect other postoperative outcomes in adult patients undergoing elective intermediate- to high-risk noncardiac surgeries compared to Southern Ontario residency?

Population

562,115 adult patients aged 18 years or older undergoing their first elective intermediate- to high-risk inpatient noncardiac surgery in Ontario, Canada between April 2009 and March 2022.

Intervention

Residence in Northern Ontario (n=41,191)

Comparator

Residence in Southern Ontario (n=520,924)

Outcome

30-day mortality following surgeryhard clinical

Northern Ontario residency was not associated with increased odds of 30-day mortality after intermediate- to high-risk elective noncardiac surgery compared to Southern Ontario residency.

Limitations

Use of health care administrative data introduces risk of misclassification bias
Health system costs may provide an incomplete picture as out-of-pocket costs were not included
Lacked measures of surgical disease severity
Results may not fully generalize to other large Canadian provinces

Abstract

PURPOSE: Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario. METHODS: We conducted a retrospective population-based cohort study using linked administrative health care data to identify all adult patients undergoing selected elective intermediate- to high-risk noncardiac surgeries in Ontario, Canada between 2009 and 2022. The primary outcome was 30-day mortality following surgery. The secondary outcomes were number of days alive at home, hospital length of stay, total health care system costs, discharge disposition, and readmissions. We used regression models to estimate the adjusted association between the exposure and outcomes. RESULTS: This study identified 562,115 patients, including 41,191 (7.3%) from Northern Ontario. We did not find strong evidence that mortality rates were higher for Northern vs Southern Ontario residents (adjusted odds ratio, 1.04; 95% confidence interval CI, 0.85 to 1.27). Health system costs were lower for Northern Ontario residents at 30 days adjusted ratio of mean (RoM), 0.92; 95% CI, 0.89 to 0.96 and at 365 days (adjusted RoM, 0.93; 95% CI, 0.90 to 0.96). Hospital length of stay was longer for Northern Ontario residents (adjusted RoM, 1.06; 95% CI, 1.01 to 1.11). The number of days alive at home and rate of readmission were not statistically different between the two groups. CONCLUSION: Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.

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