Indigenous Australian Cardiac Surgery Morbidity Comparisons

Abstract

Purpose: Indigenous Australians typically present at a much younger age for cardiac surgery compared to non-Indigenous patients. Despite this, Indigenous patients carry a substantial burden of comorbidities. These patients also face significant barriers to the access of health care from logistical, social, financial and cultural perspectives. A detailed analysis of pre, intra and postoperative characteristics was conducted. Methodology: A retrospective case audit was performed identifying 3769 cases from 1/1/2006 to 30/6/2015. Univariate analysis performed on pre, intra and postoperative variables and outcomes. All statistical analysis was performed using SPSS Ver. 23. Significance was set at p = 0.05. Results: 575 cases identified as Indigenous. 19 significant preoperative differences were: AusSCORE predicted mortality, age, BMI, serum creatinine, hypertension, smoking, substance abuse, MI within the previous 90 days, diabetes, peripheral vascular, renal disease, dialysis dependence, pulmonary hypertension, family history of cardiac disease, redo surgery, active endocarditis, urgent surgery, rheumatic heart disease and intra-aortic balloon pump use. Intraoperative differences were not significant except for a higher proportion of Indigenous patients presenting for valve only surgery. Postoperatively, Indigenous patients had significantly higher rates of dialysis. However, deep sternal wound infection rate, postoperative length of stay and rate of re-admission within 30-days were not significantly different between the groups. Conclusion: This single centre review of Indigenous cardiac surgery patients has demonstrated a greater burden of preoperative comorbidities compared with that of non-Indigenous patients. However, as outcomes for Indigenous and non-Indigenous patients were not largely dissimilar, it highlights both the quality of inpatient care but also the continued need for initiatives like Closing the Gap. Closing the Gap aims to further reduce this initial disadvantage that Indigenous patients present with by a continued focus on preventative and primary health goals. This study shows that continued support for these initiatives is still as important as when initially implemented.