Incidence of Surgical Site Infections in Indigenous Populations of the United States and Canada: A Scoping Review

Authors:
Alexandria Brackett MA, MLIS, Arpana Jain, MD, Fabrizio Darby, Jacob D. Edwards, MD, L. Andrew O. Benedict, MD, Margarita Elloso, MD, Sabrina Sanchez, MD, Shaan Bhandarkar, BS, Surgical Infection Society Diversity, Equity and Inclusion Committee N/A, Vanita Ahuja, MD, MPH, MBA

Body of Abstract:
Background: Several studies have highlighted higher rates of adverse outcomes, including superficial surgical site infections (SSI) in Indigenous populations. However, there is a paucity of review literature regarding SSI in these populations compared to other ethnic and racial groups. The aim of this project was to complete a thorough scoping review of the incidence of SSI in Indigenous populations in the USA and Canada compared to non-Indigenous patients.

Methods: Based upon systematic assessment of relevant articles found in Scopus, PubMed, and PubMed Central, a comprehensive scoping review was conducted. The search terms surgical wound infection, surgical site infection, Native American, Indigenous, and First Nation were utilized. Studies in English that were either cohort, cross-section, case-control, or randomized control studies on humans of all ages and genders were included. Studies that were reviews, case series, case reports, editorials, letters to editors, animal studies, or studies that did not examine surgical site infection as a direct outcome of surgery were excluded.

Results: We retrieved 1718 articles, 9 of which were included for review. The most reported adverse surgical infection was superficial SSI. Five studies reported a statistically significant increased risk of superficial SSI in Indigenous populations compared to white patients. Two of these studies reported outcomes from elective procedures (tympanoplasty and cervical discectomy and fusion). The tympanoplasty study showed an odds ratio of 5.503 (2.572 – 11.776; p-value<0.0001) of SSI in Indigenous patients compared to white patients; the cervical discectomy and fusion study showed an odds ratio of 2.59 (1.05 - 6.36; p-value=0.037). Increased rates of deep incisional SSI for Indigenous populations compared to white patients were statistically significant in one of three studies looking at this outcome. The study reported an odds ratio of 1.26 (1.12 - 1.41; p-value=0.0002). With regards to organ space SSI, two studies out of the three reporting this variable found statistically significant increases for Indigenous patients compared to white patients. Additionally, one study reported increases in rates of pneumonia (odds ratio=2.24; 1.58 - 3.19; p-value <0.0001) and another an increase in sepsis with prevalence of 4.3% in Indigenous populations compared to 2.3% in white patients (p-value <0.001.) Conclusions: There are statistically significant differences in the incidence of SSI and other surgical infections for Indigenous patients when compared to their white counterparts, the most glaring being increased odds of superficial SSI, though deep incisional SSI and organ space SSI rates are also elevated in these populations. Further studies are warranted to investigate causes of these increased infection rates and formulate strategies for reducing these adverse outcomes. Figure 1. PRISMA Flow Diagram of Screening Process