SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2021
Postoperative outcomes for Indigenous Peoples in Canada: a systematic review.
Open access · goldAbstract readSystematic Review
In one paragraph
Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 1 pooled it
11.1field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis.Pediatric surgery international · 2023Pooled it
- Complications of tympanostomy tubes in patients with cleft palate.Paediatrics & child health · 2026Article
- Barriers to Accessing Vascular Surgery in Northern, Rural, and Remote Canadian Communities.CJC open · 2026Review
- Cultural continuity: The product of socially accountable, culturally safe, and inclusive care.Canadian family physician Medecin de famille canadien · 2026Article
- Global health in Canadian anesthesiology residency programs: an online survey of opportunities and barriers.BMC medical education · 2025Article
- Disparities in Access to Trauma Care in Canada: A Geospatial Analysis of Census Data.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Ethnic Differences in Juvenile Idiopathic Arthritis in the Circumpolar Region.Children (Basel, Switzerland) · 2025Article
- Disparities and Barriers to Care in Plastic and Reconstructive Surgery for Native American and First Nations Populations.Plastic and reconstructive surgery. Global open · 2025Article
- Surgical Experiences of Patients From the Circumpolar North: A Scoping Review.World journal of surgery · 2025Article
- Inequities in 'failure to rescue' for Indigenous Māori after gastrointestinal cancer surgery in New Zealand.The British journal of surgery · 2025Article
- First Nations Patients' Experience Receiving Care for Cleft Lip and Palate in a Multidisciplinary Clinic Setting.Plastic surgery (Oakville, Ont.) · 2025Article
- Strategies and Recommendations to Improve Accessibility of Essential Surgery in Rural Settings in OECD Countries: A Scoping Review.World journal of surgery · 2025Article
- A standardized set of metrics to assess the quality of anesthesia, perioperative care, and acute pain management in Canada: a multidisciplinary modified Delphi study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Article
- "My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper": Indigenous experiences of liver transplantation in British Columbia, Canada.International journal of circumpolar health · 2024Article
- Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Squats, spinach, and soul: considering disparities in prehabilitation medicine before programmatic implementation.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Disparities in perioperative mortality outcomes between First Nations and non-First Nations peoples in Australia: protocol for a systematic review and planned meta-analysis.Systematic reviews · 2024Article
- Commentary: Two-Eyed Seeing (Aistotsastip) and the Medicine Wheel for the Plastic Surgeon.Plastic surgery (Oakville, Ont.) · 2024Article
- Taking action to achieve health equity and eliminate healthcare disparities within acute care surgery.Trauma surgery & acute care open · 2024Article
- The results of pancreatic surgery in Inuit patients from Greenland 1999-2022.International journal of circumpolar health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 1 institution in 1 country.
Jason A McVicarDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Alana PoonDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Nadine R CaronDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
M Dylan BouldDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Jason W NickersonDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont. jmcvicar@toh.ca.
Nora AhmadDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Donna May KimmaliardjukDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Chelsey SheffieldDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Caitlin ChampionDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
Daniel I McIsaacDepartments of Anesthesiology and Pain Medicine (McVicar, Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine (Ahmad, during the conduct of the study); Centre for Health Law, Policy and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital (McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern Ontario (Bould); Bruyère Research Institute (Nickerson), 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 (Ahmad, at time of writing), University of Toronto, Toronto, Ont.; Qikiqtani General Hospital (Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of Medicine, Sudbury, Ont.
McMaster Children's Hospital · CA
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSubstantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized.
methodsWe searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool.
resultsTwenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09-1.54;
interpretationThe currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes. PROTOCOL REGISTRATION: PROSPERO-CRD42018098757.
Indexed as
CanadaFemaleHealth Status DisparitiesHumansIndigenous CanadiansMaleOutcome Assessment, Health CarePregnancyRetrospective StudiesSurgical Procedures, Operative
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