title: Surgical morbidity and mortality among American Indian and Alaska Native veterans: a comparative analysis.
abstract: BACKGROUND
  Few studies have examined surgical risk factors and outcomes in American Indians and Alaska Natives (AI/ANs). My colleagues and I sought to determine if prevalence of preoperative risk factors for morbidity and mortality differed between male AI/AN and Caucasian surgical patients, and to determine if AI/ANs had an increased risk of surgical morbidity or mortality.
  
  
  METHODS
  We obtained data from the Veterans Affairs National Surgical Quality Improvement Program on major, noncardiac, surgical procedures performed between 1991 and 2002 for all AI/AN men (n = 2,155) and a random sample of Caucasian men (n = 2,264), matched by facility. Chi-square and t-test analyses were used to assess differences in preoperative risk factors between the two groups. Logistic regression was used to determine whether AI/AN race was independently associated with 30-day morbidity (defined as 1 or more of 21 postoperative complications) or 30-day all cause mortality after adjustment for major risk factors.
  
  
  RESULTS
  Prevalence of major preoperative risk factors for morbidity and mortality often differed between the groups. Compared with Caucasians, AI/AN race did not predict morbidity (adjusted odds ratio, 0.92; 95% CI, 0.75-1.13), but AI/ANs were at higher risk for 30-day all cause postoperative mortality (adjusted odds ratio, 1.56; 95% CI, 1.04-2.35).
  
  
  CONCLUSIONS
  Our results add postoperative mortality to health disparities experienced by AI/ANs. Future research should be conducted to identify other factors that contribute to this disparity.
authors.affiliation: Department of Surgery, Dartmouth Medical School, Lebanon, NH 03755, USA.
authors.forename: Lori Arviso
authors.initials: LA
authors.lastname: Alvord
authors.forename: Dorothy
authors.initials: D
authors.lastname: Rhoades
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Jack H
authors.initials: JH
authors.lastname: Goldberg
authors.forename: Kwan
authors.initials: K
authors.lastname: Hur
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D000368:Aged; D000413:Alaska; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016896:Treatment Outcome; D014728:Veterans; D044465:White People