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Study finds surgery risk for Native veterans

Male Native American veterans are more likely to die within a month of surgery than their white counterparts, according to a study published this month.

A team led by the first Navajo woman surgeon examined surgery records for over 2,000 American Indian and Alaska Native male veterans. When the researchers compared the data to those for white veterans, they found a striking difference.

"The results of this study add surgical outcomes to the list of health disparities experienced by Native Americans and offer further opportunities for investigation, intervention, and improvement in this understudied population," said lead author Dr. Lori Arviso Alvord, a member of the Navajo Nation who is the assistant professor of surgery and psychiatry at Dartmouth Medical School in New Hampshire.

Based on 11 years of data from the Department of Veterans Affairs, 3.1 percent of Native veterans died within 30 days of surgery, the study found. In contrast, only 2.1 percent of white patients died.

The study, published in the June 2005 issue of the Journal of the American College of Surgeons, doesn't explain the reason for the disparity. Alvord said further research is necessary to determine, for example, whether Native veterans are receiving the same amount of health care as others.

But Native veterans and their advocates say Native veterans face special challenges when seeking medical care. They must often travel hundreds of miles just to obtain basic services promised to them for enlisting in the military. They also say conditions on reservations that influence their health are poor.

"My grandfather told me, 'The better we do, the more the government will help,'" Army Sgt. Gerald Dupris, a member of the Cheyenne River Sioux Tribe who saw combat in Iraq, said earlier this year. "But Native Americans have not gotten such help."

Alvord's research confirmed that Native veterans exhibited health conditions that can increase the risk of death after surgery. Native veterans were more likely to suffer from a disability or diabetes, have a wound infection and have low platelet counts, according to the study. Platelets are necessary to deal with blood loss.

The study is the first of its kind for Native veterans but the authors noted that prior research has shown that Native American patients are at higher risk of death than non-Natives. One study showed that Native Americans received fewer kidney transplants and were delayed treatment for end-stage renal failure despite high rates of kidney disease.

Another study found that Native patient underwent fewer heart related surgeries even though heart disease is the number one killer in Indian Country. In Canada, Natives were more likely to be readmitted to hospitals after gall bladder surgery than non-Natives, according to yet another study.

A fourth study among a small group of Native Americans found that those who underwent coronary artery bypass were four times as likely to die in-hospital than whites.

"Future studies should examine in greater detail demographic, clinical, cultural, and health care factors that might account for the variation in postsurgical outcomes," the authors wrote.

Co-authors of the study include the Native Elder Health Care Resource Center at the University of Colorado Health Sciences Center, the University of Washington and Harvard Medical School. Data was obtained from the Department of Veterans Affairs' National Surgical Quality Improvement Program.

Get the Study:
Surgical Morbidity and Mortality among American Indian and Alaska Native Veterans: A Comparative Analysis (Journal of the American College of Surgeons June 2005)
Note: Full study requires subscription or paid access.

Relevant Links:
Department of Veterans Affairs -