Rachel J. Livergant (current GCGSC student) Dr. Shahrzad Joharifard, Dr. Emilie Joos (our very own Associate Director!), and members of the Global Surgery Lab and others recently published an article in the Pediatric Surgery International examining the surgical outcomes for Indigenous pediatric patients compared to non-Indigenous populations globally.
To read the full text, please visit here.
Abstract
Background: Surgical site infections (SSIs) are common and serious complications of surgery. Guidelines on preventing SSIs have been developed, but the role of preoperative bathing with plain soap among the pediatric population is unclear. We aimed to assess the effectiveness of pre-operative bathing using plain soap in preventing SSIs among pediatric surgical patients.
Materials and methods: A scoping review and meta-analysis of studies are conducted that evaluated postoperative outcomes for Indigenous pediatric patients compared to non-Indigenous populations globally. They searched nine databases for relevant subject headings including “pediatric”, “Indigenous”, “postoperative”, “complications”, and related terms. The main outcomes studied were postoperative complications, mortality, reoperations, and hospital readmission. A random-effects model was used for statistical analysis, and the Newcastle-Ottawa Scale was used for quality assessment. Fourteen studies were included in the review, and 12 met the inclusion criteria for the meta-analysis, representing 4793 Indigenous and 83,592 non-Indigenous patients.
Results: Indigenous pediatric patients had a greater than twofold overall (OR 2.06, 95% CI 1.23–3.46) and 30-day postoperative mortality (OR 2.23, 95% CI 1.23–4.05) than non-Indigenous populations. However, there are no significant differences in 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) between Indigenous and non-Indigenous children. There is also 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. Overall, the study showed that Indigenous children worldwide experience increased postoperative mortality compared to non-Indigenous populations, highlighting the need for more equitable and culturally appropriate pediatric surgical care in collaboration with Indigenous communities.
Conclusion: Indigenous pediatric patients worldwide face significant disparities in postoperative morbidity and mortality compared to non-Indigenous populations. The authors recommend collaborating with Indigenous communities to address these inequities and promote more culturally appropriate and equitable pediatric surgical care.
Keywords: Indigenous · Surgical outcomes · Health equity