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Meta-Analysis
. 2023 Feb 16;39(1):129.
doi: 10.1007/s00383-023-05377-2.

Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis

Rachel J Livergant  1 , Georgia Fraulin  1 , Kelsey Stefanyk  2 , Catherine Binda  3 , Sasha Maleki  4 , Shahrzad Joharifard  5 , Tracey Hillier  6 , Emilie Joos  7
Affiliations
Meta-Analysis

Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis

Rachel J Livergant et al. Pediatr Surg Int. .

Abstract

Mounting evidence suggests that childhood health is an important predictor of wellness as an adult. Indigenous peoples worldwide suffer worse health outcomes compared to settler populations. No study comprehensively evaluates surgical outcomes for Indigenous pediatric patients. This review evaluates inequities between Indigenous and non-Indigenous children globally for postoperative complications, morbidities, and mortality. Nine databases were searched for relevant subject headings including "pediatric", "Indigenous", "postoperative", "complications", and related terms. Main outcomes included postoperative complications, mortality, reoperations, and hospital readmission. A random-effects model was used for statistical analysis. The Newcastle Ottawa Scale was used for quality assessment. Fourteen studies were included in this review, and 12 met inclusion criteria for meta-analysis, representing 4793 Indigenous and 83,592 non-Indigenous patients. Indigenous pediatric patients had a greater than twofold overall (OR 2.0.6, 95% CI 1.23-3.46) and 30-day postoperative mortality (OR 2.23, 95% CI 1.23-4.05) than non-Indigenous populations. Surgical site infections (OR 1.05, 95% CI 0.73-1.50), reoperations (OR 0.75, 95% CI 0.51-1.11), and length of hospital stay (SMD = 0.55, 95% CI - 0.55-1.65) were similar between the two groups. There was a non-significant increase in hospital readmissions (OR 6.09, 95% CI 0.32-116.41, p = 0.23) and overall morbidity (OR 1.13, 95% CI 0.91-1.40) for Indigenous children. Indigenous children worldwide experience increased postoperative mortality. It is necessary to collaborate with Indigenous communities to promote solutions for more equitable and culturally appropriate pediatric surgical care.

Keywords: Health equity; Indigenous; Surgical outcomes.

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Conflict of interest statement

The authors have no conflicts to declare.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection process, inclusions, and exclusions
Fig. 2
Fig. 2
Risk of bias and quality assessment of included studies using the Newcastle Ottawa Scale. Red: High risk/low quality; white: unclear risk/fair quality study; green: low risk/good quality study
Fig. 3
Fig. 3
A Overall postoperative morbidity with sub-group analysis by geographic location and B postoperative surgical site infection (SSI) rate differences between Indigenous and non-Indigenous pediatric patients. Overall morbidity includes any postoperative complications, such as infectious, cardiac, respiratory, thromboembolic, bleeding, and immunologic complications
Fig. 4
Fig. 4
A Overall mortality with geographic-specific sub-group analysis and B in-hospital and 30-day postoperative mortality rates between Indigenous and non-Indigenous pediatric patients
Fig. 5
Fig. 5
A Postoperative readmission rates B reoperation rates and C length of hospital stay (days) differences between Indigenous and non-Indigenous pediatric patients
See this image and copyright information in PMC

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