EQUITY OF ACCESS TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND ROTATOR CUFF REPAIR FOR INDIGENOUS PEOPLES: A PROVINCIAL COHORT STUDY

For decades there have been repeated calls to address health inequities experienced by Canada's Indigenous peoples (First Nations, Inuit, and Metis). In 2015, the Truth and Reconciliation Committee (TRC) stated that closing the health gap between Indigenous and non-Indigenous people is critical to the reconciliation process. The purpose of this study was to evaluate access to care with respect to two commonly performed orthopaedic surgeries, anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR). Approvals were obtained from the First Nations Health & Social Secretariat of Manitoba (FNHSSM), Manitoba Inuit Association (MIA), and Manitoba Metis Federation (MMF) to undertake this study. This was a retrospective population-based cohort study comparing Indigenous and non-Indigenous peoples with respect to operative (ACLR, RCR) versus non-operative management (2015–2020). For those that underwent surgery, time from diagnosis by a primary care physician to orthopedic surgery consult (time to consult) and from consult to surgery (time to surgery) (1990–2020) were compared between groups. Data collated through the Manitoba Centre for Health Policy was utilized. For each procedure, logistic regression was performed using surgery as the dependent variable and Indigenous status as the independent variable. Kaplan-Meier survival curves were generated to compare time to consult and time to surgery for Indigenous versus non-Indigenous patients. Between 2015–2020, 91 Indigenous and 1363 non-Indigenous patients underwent ACLR, while 126 and 789 patients with the same diagnostic codes, respectively, did not. The odds of non-Indigenous patients undergoing surgery is 2.39 times (95% CI 0.79) that of Indigenous patients (p 0.001) but not for time to surgery (p=0.50). 299 Indigenous and 6496 non-Indigenous patients underwent RCR in the same time frame. Mean time to consult was 1.16 (95% CI 0.29) years and 1.04 (95% CI 0.01) years, for Indigenous compared to non-Indigenous patients, respectively. Mean time to surgery was 0.58 (95% CI 0.06) and 0.54 (95% CI 0.01) years, respectively. Survival curves were different for time to consult (p >0.02) but not for time to surgery (p=0.08). Indigenous patients diagnosed with ACL and RC tears experience longer wait times to consult a surgeon and are less likely to undergo surgical reconstruction for these injuries than non-Indigenous patients. This study is consistent with other reports that show access to care for Indigenous patients is a pervasive issue throughout the Canadian health care system. Such evidence can be utilized to formulate a plan that aligns with the health-care related TRC calls to action.