A population-based comparison of postoperative healthcare outcomes between immigrants and non-immigrants undergoing emergency general surgery in British Columbia.

BACKGROUND

The early post-operative period is critical for detecting complications among emergency general surgery (EGS) patients. Immigrants may be vulnerable to adverse post-operative outcomes due to language barriers, limited healthcare access, cultural factors or discrimination. It remains unclear whether publicly funded healthcare systems in Canada adequately meet immigrants' postoperative surgical needs.

OBJECTIVE

To compare surgical outcomes and post-operative mortality among immigrant and non-immigrant EGS patients in British Columbia, Canada.

METHODS

A population-based study using linked immigration and healthcare administrative data from 2012-2021. EGS procedures were identified using operative codes in hospital discharge data. Outcomes included length of stay (LoS), 30-day emergency department (ED) visits, readmission and reoperation within 30 days of discharge, and 1-year mortality. Sub-analyses measured outcomes since immigration and minority status.

RESULTS

Among 75,545 EGS procedures, 15.6% involved immigrants. Immigrants had shorter LoS (RR 0.85, 95%CI: 0.83-0.87) and fewer ED visits (RR 0.82, 95%CI:0.74-0.90) but higher odds of readmission (OR 1.09, 95%CI: 1.04-1.15), reoperation (OR 1.28, 95%CI: 1.11-1.46) than non-immigrants. One-year mortality (OR 1.04, 95%CI: 0.95-1.15) did not differ. Recent immigrants and visible minorities had shorter LoS and lower ED compared to more established immigrants.

CONCLUSION

Immigrants may have experienced gaps in the transition from EGS to community care. Despite shorter hospital stays and lower ED use, immigrants had higher odds of readmission and reoperation, which may reflect opportunities for early intervention as well as differences in patient preferences, social support, and post-discharge care-seeking behaviour. Targeted strategies are required to ensure safer transitions into community for immigrant patients.