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Waugh EB, Hare MJL, Story DA, Romero L, Mayo M, Smith-Vaughan H, Reilly JR. Disparities in perioperative mortality outcomes between First Nations and non-First Nations peoples in Australia: protocol for a systematic review and planned meta-analysis. Syst Rev 2024; 13:208. [PMID: 39103965 PMCID: PMC11299354 DOI: 10.1186/s13643-024-02611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 07/13/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Health inequities persist among First Nations people living in developed countries. Surgical care is pivotal in addressing a significant portion of the global disease burden. Evidence regarding surgical outcomes among First Nations people in Australia is limited. The perioperative mortality rate (POMR) indicates timely access to safe surgery and predicts long-term survival after major surgery. This systematic review will examine POMR among First Nations and non-First Nations peoples in Australia. METHODS A systematic search strategy using MEDLINE, Embase, Emcare, Global Health, and Scopus will identify studies that include First Nations people and non-First Nations people who underwent a surgical intervention under anaesthesia in Australia. The primary focus will be on documenting perioperative mortality outcomes. Title and abstract screening and full-text review will be conducted by independent reviewers, followed by data extraction and bias assessment using the ROBINS-E tool. Meta-analysis will be considered if there is sufficient homogeneity between studies. The quality of cumulative evidence will be evaluated following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. DISCUSSION This protocol describes the comprehensive methodology for the proposed systematic review. Evaluating disparities in perioperative mortality rates between First Nations and non-First Nations people remains essential in shaping the discourse surrounding health equity, particularly in addressing the surgical burden of disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021258970.
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Key Words
- Anaesthesia,
- Australia,
- Australian Aboriginal and Torres Strait Islander peoples,
- First Nations people,
- Health care,
- Health equity,
- Health status disparities
- Indigenous health,
- Meta-analysis,
- Operative,
- Outcome assessment
- Postoperative/perioperative mortality,
- Surgical procedures
- Systematic reviews,
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Affiliation(s)
- Edith B Waugh
- Department of Anaesthesia and Perioperative Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
- Flinders University, Adelaide, SA, Australia.
- Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia.
| | - Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia
| | - David A Story
- Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Health, Melbourne, VIC, Australia
| | - Mark Mayo
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer R Reilly
- Department of Critical Care, the University of Melbourne, Melbourne, VIC, Australia
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Palamuthusingam D, Hawley CM, Pascoe EM, Johnson DW, Palamuthusingam P, Boudville N, Jose MD, Cross NB, Fahim M. Postoperative Outcomes After Gastrointestinal Surgery in Patients Receiving Chronic Kidney Replacement Therapy: A Population-based Cohort Study. Ann Surg 2024; 279:462-470. [PMID: 38084600 DOI: 10.1097/sla.0000000000006179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE This study evaluated the postoperative mortality and morbidity outcomes following the different subtypes of gastrointestinal (GI) surgery over a 15-year period. BACKGROUND Patients receiving chronic kidney replacement therapy (KRT) experience higher rates of general surgery compared with other surgery types. Contemporary data on the types of surgeries and their outcomes are lacking. KRT was defined as patients requiring chronic dialysis (hemodialysis or peritoneal dilaysis) or having a functioning kidney transplant long-term. METHODS All incident and prevalent patients aged greater than 18 years identified in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry as receiving chronic KRT were linked with jurisdictional hospital admission datasets between January 1, 2000 until December 31, 2015. Patients were categorized by their KRT modality [hemodialysis (HD), peritoneal dialysis (PD), home hemodialysis (HHD), and kidney transplant (KT)]. GI surgeries were categorized as upper gastrointestinal (UGI), bowel (small and large bowel), anorectal, hernia surgery, cholecystectomy, and appendicectomy. The primary outcome was the rates of the different surgeries, estimated using Poisson models. Secondary outcomes were risks of 30-day/in-hospital postoperative mortality risk and nonfatal outcomes and were estimated using logistic regression. Independent predictors of 30-day mortality were examined using comorbidity-adjusted Cox models. RESULTS Overall, 46,779 patients on chronic KRT were linked to jurisdictional hospital datasets, and 9,116 patients were identified as having undergone 14,540 GI surgeries with a combined follow-up of 76,593 years. Patients on PD had the highest rates of GI surgery (8 per 100 patient years), with hernia surgery being the most frequent. Patients on PD also had the highest risk of 30-day postoperative mortality following the different types of GI surgery, with the risk being more than 2-fold higher after emergency surgery compared with elective procedures. Infective postoperative complications were more common than cardiac complications. This study also observed a U-shaped association between body mass index (BMI) and mortality, with a nadir in the 30 to 35 kg/m 2 group. CONCLUSIONS Patients on chronic KRT have high rates of GI surgery and morbidity, particularly in those who receive PD, are older, or are either underweight or moderately obese.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro North Kidney Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Carmel M Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Australasian Kidney Trials Network (AKTN), University of Queensland, St Lucia, Queensland, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
| | - David Wayne Johnson
- Australasian Kidney Trials Network (AKTN), University of Queensland, St Lucia, Queensland, Australia
- Translational Research Institute, Brisbane, Australia
| | | | - Neil Boudville
- Medical School, University of Western Australia, Stirling Highway, Perth, Western Australia
- Sir Charles Gairdner Hospital, Hospital Ave, Nedlands Western Australia
| | - Matthew D Jose
- Department of Nephrology, Royal Hobart Hospital, Hobart, Tasmania, Australia
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Nicholas B Cross
- Department of Nephrology, Te Whatu Ora Waitaha Canterbury, Christchurch Hospital, Christchurch, New Zealand
- Senior Clinical Lecturer, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
- Chief Medical Officer, New Zealand Clinical Research, New Zealand
| | - Magid Fahim
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Metro North Health Service, Butterfield Street, Herston, Queensland, Australia
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Boyle L, Lumley T, Cumin D, Campbell D, Merry AF. Using days alive and out of hospital to measure surgical outcomes in New Zealand: a cross-sectional study. BMJ Open 2023; 13:e063787. [PMID: 37491100 PMCID: PMC10373692 DOI: 10.1136/bmjopen-2022-063787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES To measure differences at various deciles in days alive and out of hospital to 90 days (DAOH90) and explore its utility for identifying outliers of performance among district health boards (DHBs). METHODS Days in hospital and mortality within 90 days of surgery were extracted by linking data from the New Zealand National Minimum Data Set and the births and deaths registry between 1 January 2011 and 31 December 2021 for all adults in New Zealand undergoing acute laparotomy (AL-a relatively high-risk group), elective total hip replacement (THR-a medium risk group) or lower segment caesarean section (LSCS-a low-risk group). DAOH90 was calculated without censoring to zero in cases of mortality. For each DHB, direct risk standardisation was used to adjust for potential confounders and presented in deciles according to baseline patient risk. The Mann-Whitney U test assessed overall DAOH90 differences between DHBs, and comparisons are presented between selected deciles of DAOH90 for each operation. RESULTS We obtained national data for 35 175, 52 032 and 117 695 patients undergoing AL, THR and LSCS procedures, respectively. We have demonstrated that calculating DAOH without censoring zero allows for differences between procedures and DHBs to be identified. Risk-adjusted national mean DAOH90 Scores were 64.0 days, 79.0 days and 82.0 days at the 0.1 decile and 75.0 days, 82.0 days and 84.0 days at the 0.2 decile for AL, THR and LSCS, respectively, matching to their expected risk profiles. Differences between procedures and DHBs were most marked at lower deciles of the DAOH90 distribution, and outlier DHBs were detectable. Corresponding 90-day mortality rates were 5.45%, 0.78% and 0.01%. CONCLUSION In New Zealand after direct risk adjustment, differences in DAOH90 between three types of surgical procedure reflected their respective risk levels and associated mortality rates. Outlier DHBs were identified for each procedure. Thus, our approach to analysing DAOH90 appears to have considerable face validity and potential utility for contributing to the measurement of perioperative outcomes in an audit or quality improvement setting.
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Affiliation(s)
- Luke Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - David Cumin
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Doug Campbell
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Alan Forbes Merry
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Wells CI, Varghese C, Boyle LJ, McGuinness MJ, Keane C, O'Grady G, Gurney J, Koea J, Harmston C, Bissett IP. "Failure to Rescue" following Colorectal Cancer Resection: Variation and Improvements in a National Study of Postoperative Mortality. Ann Surg 2023; 278:87-95. [PMID: 35920564 DOI: 10.1097/sla.0000000000005650] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To examine variation in "failure to rescue" (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. BACKGROUND Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. METHODS A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. RESULTS Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8-3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5-2.8), and postoperative complications (OR 1.4, 95% CI 1.3-1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4-0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4-0.7) than complications (OR 0.8, 95% CI 0.8-0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery. CONCLUSION Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in "rescue" from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of "rescue" as a target for surgical quality improvement.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Luke J Boyle
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | | | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Jonathan Koea
- Department of General Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Chris Harmston
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Northland District Health Board, Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Payne T, Braithwaite H, McCulloch T, Paleologos M, Johnstone C, Wehrman J, Taylor J, Loadsman J, Wang AY, Sanders RD. Depth of anaesthesia and mortality after cardiac or noncardiac surgery: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2023; 130:e317-e329. [PMID: 36210184 DOI: 10.1016/j.bja.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Recent randomised controlled trials have failed to show a benefit in mortality by using processed electroencephalography (pEEG) to guide lighter anaesthesia. We performed a meta-analysis of mortality data from randomised trials of pEEG monitoring to assess the evidence of any protective effect of pEEG-guided light anaesthesia compared with deep anaesthesia in adults aged ≥18 yr. METHODS Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. In February 2022, we searched three databases (Cochrane CENTRAL, OVID Medline, EMBASE) for RCTs of pEEG monitoring that provided mortality data at 30 days, 90 days, and/or 1 yr or longer. RESULTS We included 16 articles from 12 RCTs with 48 827 total participants. We observed no statistically significant mortality reduction with light anaesthesia compared with deep anaesthesia in patients aged ≥18 yr when all studies were pooled (odds ratio [OR]=0.99; 95% confidence interval (CI), 0.92-1.08). This result did not change significantly when analysing mortality at 30 days, 90 days, 1 yr or longer. We observed no mortality benefit for pEEG monitoring compared with usual care (OR=1.02; 95% CI, 0.89-1.18), targeting higher pEEG index values compared with lower values (OR=0.89; 95% CI, 0.60-1.32), or low pEEG index value alerts compared with no alerts (OR=1.02; 95% CI, 0.41-2.52). CONCLUSIONS pEEG-guided lighter anaesthesia does not appear to reduce the risk of postoperative mortality. The absence of a plausible rationale for why deeper anaesthesia should increase mortality has hampered appropriate design of definitive clinical trials. CLINICAL TRIAL REGISTRATION CRD42022285195 (PROSPERO).
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Affiliation(s)
- Thomas Payne
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
| | - Hannah Braithwaite
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Tim McCulloch
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Michael Paleologos
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Charlotte Johnstone
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Jordan Wehrman
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jennifer Taylor
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John Loadsman
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Andy Y Wang
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Robert D Sanders
- Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, New South Wales, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
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Pérez-Rivera CJ, Lozano-Suárez N, Velandia-Sánchez A, Polanía-Sandoval CA, García-Méndez JP, Idarraga-Ayala SV, Corso-Ramírez JM, Conde-Monroy D, Cruz-Reyes DL, Durán-Torres CF, Barrera-Carvajal JG, Rojas-Serrano LF, Garcia-Zambrano LA, Agudelo-Mendoza SV, Briceno-Ayala L, Cabrera-Rivera PA. Perioperative mortality in Colombia: perspectives of the fourth indicator in The Lancet Commission on Global Surgery - Colombian Surgical Outcomes Study (ColSOS) - a protocol for a multicentre prospective cohort study. BMJ Open 2022; 12:e063182. [PMID: 36450427 PMCID: PMC9716983 DOI: 10.1136/bmjopen-2022-063182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Death following surgical procedures is a global health problem, accounting for 4.2 million deaths annually within the first 30 postoperative days. The fourth indicator of The Lancet Commission on Global Surgery is essential as it seeks to standardise postoperative mortality. Consequently, it helps identify the strengths and weaknesses of each country's healthcare system. Accurate information on this indicator is not available in Colombia, limiting the possibility of interventions applied to our population. We aim to describe the in-hospital perioperative mortality of the surgical procedures performed in Colombia. The data obtained will help formulate public policies, improving the quality of the surgical departments. METHODS AND ANALYSIS An observational, analytical, multicentre prospective cohort study will be conducted throughout Colombia. Patients over 18 years of age who have undergone a surgical procedure, excluding radiological/endoscopic procedures, will be included. A sample size of 1353 patients has been projected to achieve significance in our primary objective; however, convenience sampling will be used, as we aim to include all possible patients. Data collection will be carried out prospectively for 1 week. Follow-up will continue until hospital discharge, death or a maximum of 30 inpatient days. The primary outcome is perioperative mortality. A descriptive analysis of the data will be performed, along with a case mix analysis of mortality by procedure-related, patient-related and hospital-related conditions ETHICS AND DISSEMINATION: The Fundación Cardioinfantil-Instituto de Cardiología Ethics Committee approved this study (No. 41-2021). The results are planned to be disseminated in three scenarios: the submission of an article for publication in a high-impact scientific journal and presentations at the Colombian Surgical Forum and the Congress of the American College of Surgeons. TRIAL REGISTRATION NUMBER NCT05147623.
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Affiliation(s)
- Carlos J Pérez-Rivera
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Nicolás Lozano-Suárez
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Alejandro Velandia-Sánchez
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Camilo A Polanía-Sandoval
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Juan P García-Méndez
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Sharon V Idarraga-Ayala
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | - Julián M Corso-Ramírez
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Danny Conde-Monroy
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Danna L Cruz-Reyes
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Carlos F Durán-Torres
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Juan G Barrera-Carvajal
- Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Surgery, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
| | | | - Laura Alejandra Garcia-Zambrano
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Silvia Valentina Agudelo-Mendoza
- General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Leonardo Briceno-Ayala
- Public Health Research Group, Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Paulo A Cabrera-Rivera
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
- Surgery, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
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Samper AFG, Herrera-Almario GE, Tulloch D, Blanco D, Cardoso LL, Rocha REN, Rajan R, Gracias V, Hanna JS. A granular analysis of service delivery for surgical system strengthening: Application of the Lancet indicators for policy development in Colombia. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100217. [PMID: 36777688 PMCID: PMC9904114 DOI: 10.1016/j.lana.2022.100217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Lancet Commission on Global Surgery (LCoGS) surgical indicators have given the surgical community metrics for objectively characterizing the disparity in access to surgical healthcare. However, aggregate national statistics lack sufficient specificity to inform strengthening plans at the community level. We performed a second-stage analysis of Colombian surgical system service delivery to inform the development of resource- and context-sensitive interventions to inform a revision of the Decennial Public Health Plan for access inequity resolution. METHODS Data from the year 2016 to inform total operative volume (TOV) and 30-day non-risk adjusted peri-operative mortality (POMR) were collected from the Colombian national health information system. TOV and POMR were sub-characterized by demographics, urgency, service line, disease pathology and facility location. FINDINGS In 2016, aggregate national mortality was 0·87%, while mortality attributable to elective and emergency surgery was 0·73% and 1·30%, respectively. The elderly experienced a 5·6-fold higher mortality, with 4·2% undergoing an operation within 30 days of dying. Individuals undergoing hepatobiliary, thoracic, cardiac, and neurosurgical operations experienced the highest mortality rates while obstetrics, general surgery, orthopaedics, and urology performed the largest procedure volume. Finally, analysis of operation and service line specific POMR reveals opportunities for improvement. INTERPRETATION This granular second-stage analysis provides actionable data which is fundamental to the development of resource and context-sensitive interventions to address gaps and inequities in surgical system service delivery. Furthermore, this analysis validates the modeling underlying development of the LCoGS indicators. These data will inform the assessment of implementation priorities and revision of the Colombian Decennial Public Health Plan. FUNDING None.
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Affiliation(s)
| | - Gabriel E. Herrera-Almario
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Rutgers School of Environmental and Biological Sciences, New Brunswick, NJ, USA
| | - Daniela Blanco
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | | | | | - Roshni Rajan
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
| | - Vicente Gracias
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
| | - Joseph S. Hanna
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
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8
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Pitama SG. Context is everything. ANZ J Surg 2022; 92:944-945. [PMID: 35535006 DOI: 10.1111/ans.17731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suzanne G Pitama
- The Office of the Dean, University of Otago, Christchurch, New Zealand
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9
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Gurney JK, McLeod M, Stanley J, Robson B, Campbell D, Dennett E, Ongley D, Rumball-Smith J, Sarfati D, Koea J. Regional variation in post-operative mortality in New Zealand. ANZ J Surg 2022; 92:1015-1025. [PMID: 35441428 PMCID: PMC9321085 DOI: 10.1111/ans.17510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/23/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022]
Abstract
Background There is a growing body of evidence that access to best practice perioperative care varies within our population. In this study, we use national‐level data to begin to address gaps in our understanding of regional variation in post‐operative outcomes within New Zealand. Methods Using National Collections data, we examined all inpatient procedures in New Zealand public hospitals between 2005 and 2017 (859 171 acute, 2 276 986 elective/waiting list), and identified deaths within 30 days. We calculated crude and adjusted rates per 100 procedures for the 20 district health boards (DHBs), both for the total population and stratified by ethnicity (Māori/European). Odds ratios comparing the risk of post‐operative mortality between Māori and European patients were calculated using crude and adjusted Poisson regression models. Results We observed regional variations in post‐operative mortality outcomes. Māori, compared to European, patients experienced higher post‐operative mortality rates in several DHBs, with a trend to higher mortality in almost all DHBs. Regional variation in patterns of age, procedure, deprivation and comorbidity (in particular) largely drives regional variation in post‐operative mortality, although variation persists in some regions even after adjusting for these factors. Inequitable outcomes for Māori also persist in several regions despite adjustment for multiple factors, particularly in the elective setting. Conclusions The persistence of variation and ethnic disparities in spite of adjustment for confounding and mediating factors suggests that multiple regions require additional resource and support to improve outcomes. Efforts to reduce variation and improve outcomes for patients will require both central planning and monitoring, as well as region‐specific intervention.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Bridget Robson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Dick Ongley
- Canterbury District Health Board, Christchurch, New Zealand
| | | | - Diana Sarfati
- Te Aho o Te Kahu - Cancer Control Agency, Wellington, New Zealand
| | - Jonathan Koea
- Waitemata District Health Board, Auckland, New Zealand
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Gurney JK, McLeod MA, Campbell D, Dennett E, Jackson S, Koea J, Lash N, Ongley D. Anaesthetic choice for hip or knee arthroplasty in New Zealand: Risk of postoperative death and variations in use. Anaesth Intensive Care 2021; 50:178-188. [PMID: 34871516 DOI: 10.1177/0310057x211050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral (n=86,467) and partial (n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.
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Affiliation(s)
- Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Melissa A McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Douglas Campbell
- Department of Anaesthesia and Perioperative Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Elizabeth Dennett
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sarah Jackson
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Nicholas Lash
- Department of Surgery, Canterbury District Health Board, Christchurch, New Zealand
| | - Dick Ongley
- Department of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand
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