努纳武特因纽特人在加拿大四级保健中心的术后结果：一项回顾性队列研究。
Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study.
机构信息
Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC
Department of Anesthesiology and Pain Medicine (McVicar, Hoang-Nguyen, Poon, Bould, McIsaac), University of Ottawa; The Ottawa Hospital (McVicar, Hoang-Nguyen, Kimmaliardjuk, Poon, McIsaac); Children's Hospital of Eastern Ontario (Bould), Ottawa, Ont.; Department of Anaesthesia (O'Shea), Royal Darwin Hospital, Northern Territory, Australia; Department of Surgery (Kimmaliardjuk), University of Ottawa, Ottawa, Ont.; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, Nunavut; Nunavut Tunngavik Incorporated (Allen); Bruyère Research Institute (Nickerson); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa, Ottawa, Ont.; Department of Surgery and Northern Medical Program (Caron), University of British Columbia, Prince George, BC; Centre for Excellence in Indigenous Health (Caron), University of British Columbia, Vancouver, BC.
出版信息
CMAJ Open. 2022 May 3;10(2):E304-E312. doi: 10.9778/cmajo.20210108. Print 2022 Apr-Jun.
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.
背景
医疗体系的结构方面，例如有限的获得专门外科和围手术期护理的机会，可能会对接受择期和急诊手术的患者的结局和资源利用产生负面影响。本研究的目的是比较加拿大四级保健中心的努纳武特因纽特人和非因纽特患者的术后结局。
方法
我们进行了一项回顾性队列研究，纳入 2011 年至 2018 年在渥太华医院（努纳武特地区的四级转诊医院）接受住院手术的成年（年龄≥18 岁）患者。该研究是与努纳武特因纽特人合作组织合作设计和进行的。主要结局是住院死亡或并发症的复合结局。次要结局包括术后住院时间、不良出院处理、30 天内再入院和总住院费用。
结果
在年龄为 18 至 104 岁的患者中，共有 98701 例住院手术治疗；其中 928 例（0.9%）涉及努纳武特因纽特人，97773 例涉及非因纽特患者。因纽特人发生院内死亡或术后并发症的比例高于非因纽特人（159 例[17.2%]比 15691 例[16.1%]），在调整年龄、性别、手术专业、风险和紧急程度后差异具有统计学意义（比值比[OR] 1.25，95%置信区间[CI] 1.03-1.51）。这种关联在癌症（OR 1.63，95%CI 1.03-2.58）和择期手术（OR 1.58，95%CI 1.20-2.10）患者中最为明显。调整后，因纽特人患者的再入院率、不良出院处理率、住院时间和总费用均显著升高。
结论
与非因纽特患者相比，在加拿大一家主要的四级保健医院接受手术的因纽特人术后发生发病率和死亡率的相对风险增加了 25%，而其他不良结局和资源利用的发生率也更高。需要对涉及患者、因纽特领导层、医疗保健提供者和政府的围手术期系统进行检查，以解决这些健康结局方面的差异。
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