Advertisement

Assessing the perioperative timeline and incidence of postoperative complications to optimize care for pediatric surgery patients from Northern Quebec

      Highlights

      • This study represents the first effort to characterize the pediatric surgical care model for Northern Quebec children.
      • Our results suggests that a one size fits all approach to perioperative care for Indigenous patients may not be appropriate.
      • They highlight the opportunity for remote post-surgical evaluations conducted through telemedicine.
      • This information can be shared with caregivers to promote shared decision-making in keeping with the values of Indigenous communities.

      Summary

      Background

      Patients from remote communities often require relocation to urban centres to receive surgical care. This study examines the timeline of care for pediatric surgical patients presenting to the Montreal Children’s Hospital from two remote communities in Quebec serving largely Indigenous populations. It aims to identify factors contributing to length of stay, including the incidence of post-operative complications and risk factors for complications.

      Methodology

      This was a single-center retrospective study of children from Nunavik and Terres-Cries-de-la-Baie-James who underwent general or thoracic surgery between 2011 and 2020. Patient characteristics, including risk factors for complications, and any postoperative complications were summarized descriptively. The timeline of the patient's stay from consultation to post-operative follow-up was determined through chart review, identifying the dates and modality of post-operative follow up.

      Results

      There were 271 eligible cases, including 213 urgent (79.8%) and 54 elective (20.2%) procedures. In total, four patients (1.5%) experienced a postoperative complication at follow-up. All complications occurred among patients who underwent urgent surgery. Three complications (75%) were surgical site infections, managed conservatively. Among patients who underwent elective surgery, 20% waited over 5 days prior to operation The average length of time between discharge and follow-up was one week, regardless of surgical urgency. This was the main contributor to the total time in Montreal.

      Conclusion

      Postoperative complications identified at one-week follow-up were rare and only seen following urgent surgery, suggesting that telemedicine can safely replace many in-person post-surgical follow up visits. In addition, there is room to improve wait times for those from remote communities by prioritizing displaced patients where possible.

      Keywords

      Abbreviations:

      ASA (American Society of Anesthesiologists), (ASA) physical status classification CBD (common bile duct ERCP), Endoscopic retrograde cholangiopancreatographyIQR (interquartile range MCH), Montreal Children Hospital MRN (Medical record number SIMASS), Système d'information sur les mécanismes d'accès aux services spécialisés WBC (white blood count)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Toth K.
        • Smith D.
        • Giroux D.
        Indigenous people and empowerment via technology. First Peoples Child & Family Review: An Interdisciplinary Journal Honouring the Voices, Perspectives, and Knowledges of First Peoples through Research, Critical Analyses.
        Stories, Standpoints and Media Reviews. 2018; 13 (Retrieved from:): 21-33
        • Cameron B.L.
        • Plazas Mdel P Carmargo
        • Salas A.S.
        • Bourque Bearskin R.L.
        • Hungler K.
        Understanding inequalities in access to health care services for aboriginal people: a call for nursing action.
        ANS Adv Nurs Sci. 2014 Jul-Sep; 37 (PMID: 25102218): E1-E16https://doi.org/10.1097/ANS.0000000000000039
      1. Canadian Institute for Health Information [Internet]. (2019). CIHI's Rural Health Systems Model. [updated 2019; cited 2021 March 16th]. Available from https://www.cihi.ca/en/rural-health-care-in-canada

      2. Statistics Canada [Internet]. Focus on Geography Series, c2016 Census. Model. [updated 2019; cited 2022 May 10]. Available from https://www12.statcan.gc.ca/census-recensement/2016/as-sa/fogs-spg/Facts-can-eng.cfm?Lang=Eng&GK=CAN&GC=01&TOPIC=1

      3. Truth and Reconciliation Commission of Canada. Truth and reconciliation commission of Canada: Calls to action; c2015. [updated 2015; cited 2022 June 10]. Available from: http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf

        • Holt T.
        • Hansen G.
        • McKinney V.
        • Mendez I.
        Contemplating remote presence technology for culturally safe health care for rural Indigenous children.
        AlterNative: An International Journal of Indigenous Peoples. 2019 Mar 1; 15: 31-33
        • Wilson C.R.
        • Rourke J.
        • Oandasan I.F.
        • Bosco C.
        On behalf of the Rural Road Map Implementation Committee; Au nom du Comité sur la mise en œuvre du Plan d’action sur la médecine rurale. Progress made on access to rural health care in Canada.
        Can Fam Physician. 2020 Jan; 66 (PMCID: PMC7012120): 31-36
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004 Aug; 240 (PMID: 15273542; PMCID: PMC1360123): 205-213https://doi.org/10.1097/01.sla.0000133083.54934.ae
        • Linnaus M.E.
        • Ostlie D.J.
        Complications in common general pediatric surgery procedures.
        Semin Pediatr Surg. 2016 Dec; 25 (Epub 2016 Oct 29. PMID: 27989365): 404-411https://doi.org/10.1053/j.sempedsurg.2016.10.002
        • Gomes C.A.
        • Sartelli M.
        • Di Saverio S.
        • Ansaloni L.
        • Catena F.
        • Coccolini F.
        • Inaba K.
        • Demetriades D.
        • Gomes F.C.
        • Gomes C.C.
        Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings.
        World J Emerg Surg. 2015 Dec 3; 10 (PMID: 26640515; PMCID: PMC4669630): 60https://doi.org/10.1186/s13017-015-0053-2
        • Lascano D.
        • Kelley-Quon L.I.
        Management of Postoperative Complications Following Common Pediatric Operations.
        Surg Clin North Am. 2021 Oct; 101 (Epub 2021 Jul 30. PMID: 34537144): 799-812https://doi.org/10.1016/j.suc.2021.05.021
        • Zhang P.
        • Zhang Q.
        • Zhao H.
        • Li Y.
        Factors affecting the length of hospital stay after laparoscopic appendectomy: A single center study.
        PLoS One. 2020 Dec 9; 15 (PMID: 33296384; PMCID: PMC7725291)e0243575https://doi.org/10.1371/journal.pone.0243575
        • Frongia G.
        • Mehrabi A.
        • Ziebell L.
        • Schenk J.P.
        • Günther P.
        Predicting Postoperative Complications After Pediatric Perforated Appendicitis.
        J Invest Surg. 2016 Aug; 29 (Epub 2016 Jan 29. PMID: 26822038): 185-194https://doi.org/10.3109/08941939.2015.1114690
      4. Assembly of First Nations. OCAP: ownership, control, access, and possession: First Nations’ inherent right to govern First Nations’ data [updated 2022; cited 2022 May 10]. Available from https://fnigc.ca/fr/les-principes-de-pcap-des-premieres-nations/

        • Borchardt R.A.
        • Tzizik D.
        Update on surgical site infections: The new CDC guidelines.
        JAAPA. 2018 Apr; 31 (PMID: 30973535): 52-54https://doi.org/10.1097/01.JAA.0000531052.82007.42
        • Thompson H.
        • Jones C.
        • Pardy C.
        • Kufeji D.
        • Nichols E.
        • Murphy F.
        • Davenport M.
        Application of the Clavien-Dindo classification to a pediatric surgical network.
        J Pediatr Surg. 2020 Feb; 55 (Epub 2019 Nov 4. PMID: 31727385): 312-315https://doi.org/10.1016/j.jpedsurg.2019.10.032
        • Young K.
        • Gupta A.
        • Palacios R.
        Impact of Telemedicine in Pediatric Postoperative Care.
        Telemed J E Health. 2019 Nov; 25 (Epub 2018 Dec 5. PMID: 30517056): 1083-1089https://doi.org/10.1089/tmj.2018.0246
        • Shivji S.
        • Metcalfe P.
        • Khan A.
        • Bratu I.
        Pediatric surgery telehealth: patient and clinician satisfaction.
        Pediatr Surg Int. 2011 May; 27 (PMID: 21243367): 523-526https://doi.org/10.1007/s00383-010-2823-y
        • Metzger G.A.
        • Cooper J.
        • Lutz C.
        • Jatana K.R.
        • Nishimura L.
        • Deans K.J.
        • Minneci P.C.
        • Halaweish I.
        The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond.
        J Pediatr Surg. 2021 Aug; 56 (Epub 2021 Feb 19. PMID: 33648729; PMCID: PMC7894074): 1305-1311https://doi.org/10.1016/j.jpedsurg.2021.02.018
        • Metzger G.A.
        • Cooper J.
        • Lutz C.
        • Jatana K.R.
        • Nishimura L.
        • Deans K.J.
        • Minneci P.C.
        • Halaweish I.
        Recognizing the Benefit of Telemedicine Before and After COVID-19: A Survey of Pediatric Surgery Providers.
        J Surg Res. 2021 Nov; 267 (Epub 2021 May 24. PMID: 34171563; PMCID: PMC8141788): 274-283https://doi.org/10.1016/j.jss.2021.05.019