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Report finds equity gap in NZ surgical systems for Māori

Perioperative Mortality Review Committee
17 December 2019

The Perioperative Mortality Review Committee is calling on surgeons, anaesthetists and clinicians to address inequities in surgical services.

The committee’s eighth report, published today, has found Māori admitted to New Zealand hospitals for acute laparotomy have about 60 percent greater mortality after adjustments for age.

The committee reviews deaths related to surgery and anaesthesia that occur within 30 days of an operation. It advises the Health Quality & Safety Commission on how to reduce these deaths and makes recommendations to make surgery safer for patients.

The report analyses perioperative mortality between 2012 to 2017 on surgical outcomes for Māori following acute laparotomy. Laparotomy is a surgical incision into the abdomen, for diagnosis or in preparation for major surgery. The procedure is required to deal with surgical emergencies and is associated with high death rates.

Committee chair Dr Tony Williams says patients requiring this type of urgent surgery are at risk of complications and providing good care to them is a measure of the ability of our hospitals to provide the complex care required.

The report makes recommendations on improvements to Māori surgical outcomes, improvements to surgical care and provides directions for further research and research funding.

‘All surgical departments should commit to Te Tiriti o Waitangi and achieving equitable outcomes for Māori. They should review Māori mortality and morbidity outcomes, and consider how the surgical pathway may contribute to these inequities,’ he says.

‘This is a situation that will require the collective effort of the whole health system to redress.’

The report also recommends surgical staff undertake training on Te Tiriti, anti-racism, cultural safety and competency.

‘Many of the causes of these inequities have their genesis outside the hospital and as practitioners we may feel there is little we can do – but the reality is we all share the responsibility to improve outcomes. I think we must all reflect on our own practice, because treating people as we always have done will lead to the results we have always seen.’

The report also advises on best practice when providing care to Māori patients and whānau including:

  • understanding what is important to whānau
  • reflecting and being self-aware of any bias
  • committing to enhance cultural competency to provide culturally safe care
  • acknowledge a differing world view between your own and Te Ao Māori (Māori worldview) and hauora (overall physical, mental and spiritual health)
  • provide the highest level of care by making senior clinicians available for procedures.

The report also endorses all National Emergency Laparotomy Audit recommendations, such as having a consultant present during surgery for high risk patients undergoing emergency laparotomy.

It also supports quality improvement in emergency laparotomy and endorses the Australia and New Zealand Emergency Laparotomy Audit-Quality Improvement project.

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