Study indicates Indigenous peoples 30 per cent more likely to die after surgery, though data is lacking

A study published today in the Canadian Medical Association Journal shines light on the question of Indigenous peoples and surgical outcomes.

“Postoperative outcomes for Indigenous Peoples in Canada: a systemic review” is the first study to analyze all available surgical outcome data for the Indigenous populations.

“This pandemic has exposed the social disparities and the disproportionate affects on specific populations, and I think this research illuminates inequities that are built into our surgical system,” said Dr. Jason McVicar.

McVicar, a Métis anesthesiologist at The Ottawa Hospital and assistant professor at the University of Ottawa, is one of nine authors of the study. He is joined by two other Indigenous authors, Dr. Nadine Caron, a First Nations general surgeon, and Dr. Donna May Kimmaliardjuk, an Inuk cardiac surgeon.

McVicar says Caron identified an existing knowledge gap specific to surgical outcomes for Indigenous peoples in Canada and called for the study to be undertaken.

The team discovered that data for Indigenous patients was woefully lacking. They identified 28 previously published studies, dating back as far as 1989, that compared surgical outcomes of Indigenous peoples with non-Indigenous people. Adjusting for variables, of the 1.9 million patients in the studies, 10.2 per cent identified as Indigenous. Then using the only four suitable studies, an analysis indicated that after matching Indigenous with non-Indigenous patients who had similar surgeries, age and medical conditions, Indigenous peoples were 30 per cent more likely to die after surgery.

Systemic discrimination is one reason for the high mortality rate.

“These health inequities are direct impacts of the social determinants of health, which are in turn effects of colonialism and government policies, including the Indian residential school system. People living in remote regions have less access to publicly funded health care …with worse outcomes,” reads the report.

McVicar points out that any patient undertaking surgery does better the “healthier they are when they walk in the door.”

McVicar says he was “concerned” to discover through the data that Indigenous peoples have a lower rate of utilizing potential life-saving procedures or elective surgeries aimed at improving their life.

The study found higher rates of complications for Indigenous people undergoing cardiac surgery and renal events; and higher rates of postoperative complications and hospital readmissions.

Systemic discrimination is also a reason noted for why the statistics for people identifying as Indigenous is low.

“Patients are concerned about identifying for fear… it might affect their care in terms of knowing both systemic discrimination or incidences of racism in the health care system,” said McVicar.

There is also a practical aspect to this lack of Indigenous data.

“We're a federated country. We have 14 different health care systems if you include the First Nations Inuit Health Branch. The way that we collect data on people is completely different across the country,” said McVicar, even to the point that some hospitals have paper records while others have electronic records.

What little data was collected on surgical outcomes for Indigenous patients does not distinguish between the three distinct peoples.

McVicar was surprised to discover in doing this research that there was no data specific to Métis or Inuit peoples.

“We need better data but the data that we do have tells us we need to do better,” said McVicar.

The authors of the study call for further research and data collecting to be directed by Indigenous communities.

“Indigenous health research has been dominated by non-Indigenous researchers for a very long time. We’re seeing that this is beginning to change. There's a new generation of engaged Indigenous health researchers and healthcare providers and we're excited about seeing Indigenous health research being led by First Nations, Inuit and Métis scholars,” said McVicar.

He points out that the evidence collected through the studies is determined by the questions asked.

“If you don't understand the context of the lived experience of the populations that are being studied then the chances of you asking the right questions, and the chances that you are actually getting to the real meat of what the issues are, I think the ability to be able to do this properly is impaired,” he said.

This study is the “introduction of the first chapter. This study is putting it all together so we have more context, but what it allows us to do is to take the signals that exist and go back to the communities and ask them what their priorities are,” he added.

“The more information that we have to drive decisions in real time and to affect and to measure the outputs of our current policies, allow us to objectively reframe how we’re doing things in order to produce better outcomes.”

Will those better surgical outcomes be realized in this time of the coronavirus pandemic?

“As COVID cases surge we have a surgical backlog that is increasing …When we go back to address the backlog, those with the political agency to strongly advocate for themselves, they’re going to get to the front of the line first, right? And I think that’s going to disproportionately affect First Nations, Inuit and Métis communities….

“The ripple effects from what the disruption of the system is right now is going to be felt for years to come,” said McVicar.

Local Journalism Initiative Reporters are supported by a financial contribution made by the Government of Canada.