From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine).
From the Department of Surgery, University of Alberta, Edmonton, Alta. (Hsiao, Fathimani, Williams); Data and Research Services, Alberta SPOR Support Unit, Edmonton, Alta. (Youngson); Provincial Research Data Services, Alberta Health Services, Edmonton, Alta. (Youngson); and the Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alta. (Lafontaine)
Can J Surg. 2023 Nov 15;66(6):E540-E549. doi: 10.1503/cjs.011222. Print 2023 Nov-Dec.
Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This study compares outcomes after appendectomy in First Nations and non-First Nations patients.
In this population-based study, we reviewed administrative data of patients who underwent appendectomy between Apr. 1, 2004, and Mar. 31, 2017, in Northern Alberta. Demographic variables and characteristics of surgical care for First Nations and non-First Nations patients were collected. We identified adverse outcomes by the presence of predefined administrative codes. We identified variables related to a complex postoperative course (at least 1 of wound dehiscence, surgical site infection, abscess, bowel obstruction, pneumonia, deep vein thrombosis, sepsis, emergency department visit, readmission or death within 30 d after appendectomy) through a logistic regression model, and those related to longer length of stay using a Cox proportional hazards model.
A total of 28 453 patients met the selection criteria, of whom 1737 (6.1%) had First Nations status. Compared to non-First Nations patients, First Nations patients were younger, lived farther away from the hospital of their appendectomy, were in lower socioeconomic quintiles, and had higher rates of obesity and diabetes (all < 0.001). After adjustment for age, sex, distance to hospital, socioeconomic deprivation and comorbidities, First Nations status remained independently associated with higher rates of adverse outcomes (odds ratio 1.548, 95% confidence interval [CI] 1.384-1.733) and longer lengths of stay (hazard ratio 0.877, 95% CI 0.832-0.924).
Although rurality, comorbidities and socioeconomic status contributed to worse outcomes after appendectomy for First Nations patients, First Nations status remained independently associated with worse surgical outcomes. Surgical care, an integral component of health care delivery, must be improved for First Nations patients in order to achieve equitable health care.
在国际上，原住民患者的手术结果比非原住民患者差，但在加拿大，外科手术护理的公平性研究较少。本研究比较了第一民族和非第一民族患者阑尾切除术后的结果。
在这项基于人群的研究中，我们回顾了 2004 年 4 月 1 日至 2017 年 3 月 31 日在阿尔伯塔省北部接受阑尾切除术的患者的行政数据。收集了第一民族和非第一民族患者的人口统计学变量和手术护理特征。我们通过预先设定的行政代码确定不良结果。我们通过逻辑回归模型确定了与复杂术后过程（至少有 1 例伤口裂开、手术部位感染、脓肿、肠梗阻、肺炎、深静脉血栓形成、败血症、急诊就诊、术后 30 天内再次入院或死亡）相关的变量，并通过 Cox 比例风险模型确定了与较长住院时间相关的变量。
共有 28453 名患者符合入选标准，其中 1737 名（6.1%）具有第一民族身份。与非第一民族患者相比，第一民族患者年龄较小，距离阑尾切除术医院较远，社会经济地位较低，肥胖和糖尿病的发生率较高（均<0.001）。在校正年龄、性别、距离医院、社会经济剥夺和合并症后，第一民族身份与不良结局的发生率较高（优势比 1.548，95%置信区间[CI] 1.384-1.733）和较长的住院时间（风险比 0.877，95%CI 0.832-0.924）独立相关。
尽管农村、合并症和社会经济状况导致第一民族患者阑尾切除术后的结局更差，但第一民族身份与手术结果较差仍独立相关。为了实现公平的医疗保健，必须改善第一民族患者的外科护理，这是医疗保健提供的一个组成部分。
