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


      • 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.



      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.


      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.


      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.


      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.



      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)
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