New Zealand's Perioperative Mortality Review Committee (POMRC) recently reported that, between 2009-2013, Māori New Zealanders were 62 per cent more likely to die within 30 days following an elective or waiting list procedure (adjusted odds ratio [OR]: 1.62, 95% CI 1.33-1.97) – even after adjusting for age, gender, deprivation and physical status ('ASA' score).
There is an urgent need to describe in detail the extent to which disparities in postoperative mortality exist between Māori and non-Māori, particularly for surgical procedures that are major causes of postoperative mortality and/or morbidity. This research also needs to measure the extent to which any observed disparities are explained by patient-level factors, surgical quality-of-care factors and health system level factors (as outlined above). The factors that drive postoperative mortality among Māori may be different to the factors that drive postoperative mortality for non-Māori; also, the magnitude of the impact of common factors (such as comorbidity) may differ between Māori and non-Māori. It is crucial that we understand where these differences lie, in order to best-inform our actions to address them.
Our research in this area focusses on a) comparing the risk of post-operative mortality between Māori and non-Māori New Zealanders across multiple surgical specialties, and b) identifying the key drivers of observed disparities. To achieve this, we have received project funding from the Health Research Council of New Zealand as part of the 2018 round (HRC reference #: 18/037).
Key publications
Gurney, J., McLeod, M., Stanley, J., Sarfati, D., Campbell, D., Davies, C., Dennett, E., Himona, P., Jackson, S., Ongley, D., Robson, B., Rumball-Smith, J., Signal, V., Stairmand, J., Thomas, C., Koea, J. Disparities in post-operative mortality between Māori and non-indigenous ethnic groups in New Zealand. New Zealand Medical Journal, Accepted and In-Press.
Gurney, J., McLeod, M., Campbell, D., Dennett, E., Jackson, S., Koea, J., Lash, N., Ongley, D. Anaesthetic choice for hip or knee arthroplasty in New Zealand: risk of post-operative death and variations in use. Anaesthesiology and Intensive Care, Accepted and In-Press.
Gurney, J., McLeod, M., Stanley, J., Campbell, D., Dennett, E., Jackson, S., Koea, J., Ongley, D., Sarfati, D. (2020). Post-operative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends. BMJ Open, 10, e036451, p1-11.
McLeod, M., Signal, V., Gurney, J., Sarfati, D. (2020). Post-operative mortality of Indigenous compared to non-Indigenous populations: a systematic review. JAMA Surgery, 155(7), p636-656.
Sanket Srinivasa, Jason Gurney, Jonathan Koea (2019). Potential Consequences of Patient Complications for Surgeon Well-being: A Systematic Review. JAMA Surgery, 154(5), p451-457
Gurney, J., Stanley, J., Rumball-Smith, J., York, S., Sarfati, D. (2018). Postoperative death following lower limb amputation in a national prevalent cohort of patients with diabetes. Diabetes Care, 41(6):p1204-1211.