1
|
Maas Z, Carson DA, McIntyre RA, Rahiri JL, Wells C, Cribb B, Omundsen M, Holm TM. Comparing return of bowel function after right versus extended right hemicolectomy: a retrospective analysis. ANZ J Surg 2024; 94:697-701. [PMID: 38041237 DOI: 10.1111/ans.18807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Prolonged postoperative ileus (PPOI) is associated with higher morbidity and extended inpatient stay. Although evidence suggests that PPOI is more common following right-sided resections, it is uncertain if return to bowel function is similar following extended right (ERH) versus right hemicolectomy (RH). METHODS The recovery of patients undergoing ERH and RH in a regional hospital in New Zealand was retrospectively compared, from 2012 to 2021. Rates of PPOI, return of bowel function and postoperative complications were compared. Other factors potentially relating to PPOI were analysed. RESULTS 293 patients were included (42 who underwent ERH, and 251 RH). PPOI was more common following ERH than RH (43% vs. 25%, P = 0.02). When accounting for the operative approach, rate of PPOI was not significantly different (42% open ERH vs. 36% open RH; P = 0.56). Excluding PPOI, return of bowel function did not differ between groups. Patient undergoing ERH versus RH had significantly higher length of stay (1 day) and Hb drop (2.5 g/L) postoperatively. CONCLUSION Higher rates of PPOI have been demonstrated in ERH versus RH however when controlling for approach, there was not a significant difference. Further interrogation into rates of PPOI (particularly after laparoscopic surgery) are warranted to tailor locoregional ERAS protocols.
Collapse
Affiliation(s)
- Zak Maas
- Department of General Surgery, Tauranga Hospital, Tauranga, New Zealand
| | - Daniel A Carson
- Department of General Surgery, Tauranga Hospital, Tauranga, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rachel A McIntyre
- Department of Obstetrics & Gynaecology, Tauranga Hospital, Tauranga, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cameron Wells
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Benjamin Cribb
- Department of General Surgery, Tauranga Hospital, Tauranga, New Zealand
| | - Mark Omundsen
- Department of General Surgery, Tauranga Hospital, Tauranga, New Zealand
| | - Teresa M Holm
- Department of General Surgery, Tauranga Hospital, Tauranga, New Zealand
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Kee R, Clifford K, Maloney J, Mangu A, Cain J, Memon S, Rahiri JL. A retrospective cohort study of incidental abdominal aortic aneurysms on routine abdominal computed tomography scans in Te Tairāwhiti (2018-2019). N Z Med J 2024; 137:30-40. [PMID: 38452230 DOI: 10.26635/6965.6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
AIM Ruptured abdominal aortic aneurysm (rAAA) is associated with a high mortality rate which, is especially significant in rural and provincial regions. In Aotearoa New Zealand, Māori experience higher rates of AAA and worse overall medium-term survival following AAA repair. This study aimed to understand the prevalence of incidental AAA on routine abdominal computed tomography (CT) scans over 12 months. METHOD A retrospective review of all abdominal CT scans performed on patients ≥50 years at Gisborne Hospital between 1 December 2018-1 December 2019 was performed. RESULTS A total of 811 scans were reviewed, with 42 incidental AAA detected (5.2%). The majority of incidental AAA were in males aged ≥65 (65.8%), with a higher prevalence for Māori compared to New Zealand European (NZE) (16.2% vs 8.1%, p=0.052). This pattern was also seen in females, aged ≥65 (10.9% in Māori vs 3.8% in NZE, p=0.047). CONCLUSION The detection of AAA on routine abdominal CT scans appears to be a useful adjunct in lieu of targeted AAA screening in our region. A high prevalence of incidental AAA (5.2%) over 12 months, with a significantly higher prevalence noted in Māori males and females ≥65 years (16.2% and 10.9%), was observed.
Collapse
Affiliation(s)
- Rachel Kee
- Department of Surgery, Te Whatu Ora Tairāwhiti, Gisborne, New Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
| | - Jay Maloney
- Department of Surgery, Te Whatu Ora Tairāwhiti, Gisborne, New Zealand
| | - Atareta Mangu
- Whānau Engagement Manager, Te Puni Kōkiri Ikaroa-Rāwhiti, Gisborne
| | - Justin Cain
- Department of Vascular, Endovascular and Transplant Surgery, Te Whatu Ora Capital, Coast and Hutt Valley
| | - Sameer Memon
- Department of Surgery, Te Whatu Ora Tairāwhiti, Gisborne, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, Te Whatu Ora Tairāwhiti, Gisborne, New Zealand; Te Piringa Kōtuku Research, Tuhauora Medical Associates, Auckland, New Zealand
| |
Collapse
|
3
|
Tolmay S, Rahiri JL, Snoep K, Fewster G, Kee R, Lim Y, Watson B, Richter KK. Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting. ANZ J Surg 2024. [PMID: 38205533 DOI: 10.1111/ans.18838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) programs have become increasingly popular in the management of patients undergoing colorectal resection. However, the validity of ERAS in rural hospital settings without intensive care facilities has not been primarily evaluated. This study aimed to assess an ERAS protocol in a rural surgical department based in Invercargill New Zealand. METHODS Ten years of prospectively collected data were analysed retrospectively from an ERAS database of all patients undergoing open, converted, or laparoscopic colorectal resections. Data were collected between two time periods: before the implementation of an ERAS protocol, from January 2011 to December 2013; as well as after the implementation of an ERAS protocol, from January 2014 to December 2020. The primary outcome measures were hospital length of stay (LOS) and LOS in the critical care unit (LOS-CCU). Secondary outcomes were compliance with ERAS protocol, mortality, readmission, and reoperation rates. RESULTS A total of 118 and 558 colorectal resections were performed in the pre-ERAS and ERAS groups respectively. A statistically significant reduction in hospital LOS was achieved from a median of 8 to 7 days (P = 0.038) when comparing pre-ERAS to ERAS groups respectively. Furthermore, a significant reduction in re-operation rates was observed (7.6% vs. 3% in the ERAS group, P = 0.033) which was seen without a rise in readmission rates (13.6% vs. 13.6% in the ERAS group). CONCLUSION The implementation of ERAS in a rural surgical setting is feasible, and these initial findings suggest ERAS adds value in optimizing the colorectal patient's surgical journey.
Collapse
Affiliation(s)
- Stephen Tolmay
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Kim Snoep
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Gillian Fewster
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Rachel Kee
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Yukai Lim
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Bridget Watson
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Konrad Klaus Richter
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
- Dunedin School of Medicine, University of Otago, New Zealand
| |
Collapse
|
4
|
Bradley K, Cowan S, Babor R, Morrow J, MacCormack A, Rahiri JL, Murphy R. Investigating the distribution of primary and secondary care referrals for public-funded bariatric surgery at Counties Manukau Health (CMH). N Z Med J 2023; 136:65-75. [PMID: 37778320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
AIMS This study investigated variations in referral rates for bariatric surgery from primary and secondary care providers across the Counties Manukau district health board (CMDHB), with the aim of identifying "hot spots" for referrals so that intervention to help achieve equitable access to bariatric surgery can be implemented. METHODS Referral data was gathered from hospital referral records from January 2017 to January 2019 (n=1,440). Referral rate per geographical location within the CMDHB catchment was calculated using 2018 census figures. RESULTS Of the 1,195 referrals included, 1040 (87%) referrals were from primary care. The referrals came from 328 general practitioners (GPs) across 158 practices. There was considerable regional variation in referral rates per 1000 people, from a peak of 71.5/1000 to a low of 0.2/1000. Eighty-six percent of secondary care referrals were received from the public system and the remainder from private practice. The most common referral specialty was diabetes, followed by general surgery and orthopaedics. Out of these referrals, 434 (36%) proceeded to bariatric surgery. Pākehā (50%) were more likely to proceed to surgery than Māori (31%) and Pasifika (22%), despite similar referral numbers. CONCLUSION There is significant variation in referrals for bariatric surgery across CMDHB. Systematic discussion of bariatric surgery with every patient who is likely to benefit is not occurring, given relatively low referral volumes.
Collapse
Affiliation(s)
- Kate Bradley
- Department of Older Peoples Health, Middlemore Hospital - Te Whatu Ora - Health NZ
| | - Sarah Cowan
- General Surgical Department, Taranaki Base Hospital - Te Whatu Ora - Health NZ
| | - Richard Babor
- Department of Surgery, Counties Manukau - Te Whatu Ora - Health NZ
| | - Jon Morrow
- Department of Surgery, Counties Manukau - Te Whatu Ora - Health NZ
| | - Andrew MacCormack
- Department of Surgery, Counties Manukau - Te Whatu Ora, New Zealand; Department of Surgery, Faculty of Medicine and Health Sciences, The University of Auckland
| | - Jamie-Lee Rahiri
- General Surgical Department, Taranaki Base Hospital - Te Whatu Ora - Health NZ
| | - Rinki Murphy
- Medical Bariatric Service, Counties Manukau - Te Whatu Ora, New Zealand; Department of Medicine, Faculty of Medicine and Health Sciences, The University of Auckland
| |
Collapse
|
5
|
Tutone S, Fuimaono-Asafo A, Wilson A, Harwood M, Love R, Rahiri JL. The Surgical Sisterhood - The Experiences of wāhine Māori and Pasifika Aspiring Surgeons. Qual Health Res 2023; 33:106-116. [PMID: 36538013 DOI: 10.1177/10497323221144929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a surgical sisterhood to support them towards applying for advanced surgical training. Utilising mana wāhine and Masi methodologies, semi-structured interpersonal interviews were undertaken with five wāhine who formed the surgical sisterhood. Following transcription and analysis of all interviews, four key themes were identified. These were mana wāhine, unity, our why and change on the horizon. These themes illustrate the complex and varied experiences of wāhine Māori and Pasifika and how they have navigated their surgical pathways amidst multiple layers of discrimination towards being in a position to apply for advanced surgical training.
Collapse
Affiliation(s)
- Senitila Tutone
- Department of Surgery, 1406Waitematā District Health Board, Auckland, New Zealand
| | | | - Ailsa Wilson
- Department of Orthopaedics, 8458Capital and Coast District Health Board
| | - Matire Harwood
- Department of General Practice and Primary Health Care, 1415the University of Auckland, Auckland, New Zealand
| | - Rachelle Love
- Department of Otorhinolaryngology, 63588Canterbury District Health Board, Christchurch, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, 89490Taranaki Base Hospital, New Plymouth, New Zealand
| |
Collapse
|
6
|
Rahiri JL, Tuhoe J, Harwood M, Koea J. Understanding surgical disease and care for Māori in Aotearoa: protocol for a scoping review. BMJ Open 2022; 12:e058784. [PMID: 35383085 PMCID: PMC8984033 DOI: 10.1136/bmjopen-2021-058784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Māori continue to experience inequitable healthcare and health outcomes compared with other New Zealanders. A narrative review conducted in 2016 described disparities in access to and through the surgical care pathway for Māori from a limited pool of small retrospective cohort studies. This review only targeted studies that specifically investigated surgical care for Māori; however, many other studies have performed subanalyses for Māori as part of bigger ethnographic epidemiological studies and Indigenous health has become more topical in Australasia since this review was conducted. Health disparities and inequities in surgical care for Māori are still not well understood. This scoping review aims to report the nature and extent of disparities in surgical disease and care for Māori. METHODS AND ANALYSIS A scoping review will be performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. This study will be informed by Kaupapa Māori research methodology. Electronic searches of PubMed, MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature Plus will be performed between 19 February and 19 March 2022. Two authors will independently identify and retrieve relevant texts in an iterative manner and examine how responsive each of the included studies are to Māori using the recently described Māori framework-a framework designed to guide researcher responsiveness to Māori. ETHICS AND DISSEMINATION Ethical approval has not been sought as our review will only include published and publicly accessible data. We will publish the review in an open access peer-reviewed surgical journal. This protocol has been registered in Open Science Framework (10.17605/OSF.IO/NP4H3).
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, Waitemata District Health Board, Takapuna, New Zealand
| | - Jason Tuhoe
- Department of General Practice, Royal New Zealand College of General Practitioners, Auckland, New Zealand
| | - Matire Harwood
- General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitemata District Health Board, Takapuna, New Zealand
| |
Collapse
|
7
|
Hawley L, Narayan J, Kulasegaran S, Harman R, Rahiri JL, Holm TM. An unusual case of 'Mycobacterium tuberculosis' peritonitis at Waitematā District Health Board. N Z Med J 2022; 135:121-124. [PMID: 35728177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Luke Hawley
- House officer, Department of General Surgery, North Shore Hospital, Waitematā District Health Board
| | - Josh Narayan
- House officer, Department of General Surgery, North Shore Hospital, Waitematā District Health Board
| | - Suheelan Kulasegaran
- Registrar, Department of General Surgery, North Shore Hospital, Waitematā District Health Board
| | - Richard Harman
- General Surgeon, Department of General Surgery, North Shore Hospital, Waitematā District Health Board
| | - Jamie-Lee Rahiri
- Registrar, Department of General Surgery, North Shore Hospital, Waitematā District Health Board and Postdoctoral Fellow, Department of Surgery, University of Auckland
| | - Teresa M Holm
- Registrar, Department of General Surgery, North Shore Hospital, Waitematā District Health Board and Postdoctoral Fellow, Department of Department of Molecular Medicine and Pathology, FMHS, University of Auckland
| |
Collapse
|
8
|
Tolmay S, Koea J, Stewart I, Rahiri JL. Falling through the cracks: Evaluating the role of nonacute surgical liaison personnel during COVID-19-A narrative review. Surgery 2022; 171:437-446. [PMID: 34728081 PMCID: PMC8410577 DOI: 10.1016/j.surg.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In March 2020, in response to the COVID-19 pandemic, the New Zealand government instituted a 4-level alert system, which resulted in the rapid dissolution of nonurgent surgical services to minimize occupational exposure to both patients and staff, with the primary health sector bearing most of the diverted caseload. Consequently, the study authors sought to collate information around the establishment of a supportive nonacute surgical liaison role in a public hospital surgical department, with an interest in establishing this role in New Zealand. METHODS The narrative review conducted systematically in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases searched included Pubmed, MEDLINE, Embase, and Cochrane Controlled Register of Trials. A deductive analysis was applied using a demand management model developed by the Institute for Innovation and Improvement at Waitematā District Health Board. All included studies were rated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool. RESULTS Collation of 19 studies resulted in 3 key findings: first, that a surgical liaison could be utilized at the primary care to specialist interface to improve communication and workflow between services. Second, a liaison could be utilized directly communicating with patients as a means of increasing engagement and self-management. Finally, this service can be offered through multiple modalities including a noncontact telehealth service. CONCLUSION Evidence of nonacute surgical liaisons both internationally and specifically within New Zealand has been collated to provide evidence for its application.
Collapse
Affiliation(s)
- Stephen Tolmay
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand,Reprint requests: Stephen Tolmay, MBChB, Department of Surgery, Waitematā District Health Board & The University of Auckland, North Shore Hospital, 24 Shakespeare Road, Takapuna, Auckland 0620
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Waitematā District Health Board, Auckland, New Zealand
| | - Ian Stewart
- Department of Surgery, North Shore Hospital, Waitematā District Health Board, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, North Shore Hospital, Waitematā District Health Board, Auckland, New Zealand
| |
Collapse
|
9
|
Rahiri JL, Koea J, Pitama S, Harwood M, Aramoana J, Brown L, Love R, Curtis E, Reid P, Ronald M. Protecting Indigenous Māori in surgical research: a collective stance. ANZ J Surg 2021; 90:2396-2399. [PMID: 33336484 DOI: 10.1111/ans.16356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Suzanne Pitama
- Māori/Indigenous Health Institute, The University of Otago, Christchurch, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Jaclyn Aramoana
- Department of Surgery, Northland District Health Board, Whangarei, New Zealand
| | - Lisa Brown
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Rachelle Love
- Department of Otolaryngology, Christchurch Public Hospital, Christchurch, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori, The University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, The University of Auckland, Auckland, New Zealand
| | - Maxine Ronald
- Department of Surgery, Northland District Health Board, Whangarei, New Zealand
| |
Collapse
|
10
|
Panesar D, Rahiri JL, Koea J. Indigenous Health Leadership: A Kaupapa MāoriPerspective from Aotearoa – New Zealand. leader 2021. [DOI: 10.1136/leader-2021-000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This article describes the challenge of addressing indigenous health leadership to reduce ethnic disparity in modern healthcare. The indigenous New Zealand population, Māori, are disadvantaged across many health domains including the socioeconomic determinants of health. The Treaty of Waitangi, considered New Zealand’s founding document, outlines Māori autonomy and leadership, and can be applied to a model of health equity. Leadership frameworks in this sense must incorporate ethical and servant leadership styles across a shared, distributive leadership model to develop safe and equitable health environments where Indigenous ways of being and knowing are not subjugated. This is a shift from traditional hierarchical paradigms of the past and acknowledges Māori as having the autonomy to lead and maintain equitable health outcomes.
Collapse
|
11
|
Koea J, Rahiri JL, Ronald M. Affirmative action programmes in postgraduate medical and surgical training-A narrative review. Med Educ 2021; 55:309-316. [PMID: 32895996 DOI: 10.1111/medu.14350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This review aims to identify and summarise the literature pertaining to the implementation of affirmative action programmes (AAP) for selection of ethnic minorities and Indigenous peoples into selective specialist medical and surgical training programmes. METHODS A systematic literature search was conducted to identify relevant studies reporting on the background, implementation and results of AAP for ethnic minorities and Indigenous peoples into medical and surgical training. MEDLINE, EMBASE, PubMed, Scopus and Google Scholar databases were queried from inception through to 1 February 2020. All included studies were subjected to inductive thematic analysis in order to systematically collate study findings. Articles were read through several times in an iterative manner to allow the identification of themes across the included studies. The themes were cross-compared among the authors to establish their interconnectedness. RESULTS Forty-five articles described AAP pertaining to ethnic minorities in the United States of America (African-Americans and Hispanic Americans), women and ethnic minorities, Indigenous peoples (New Zealand Māori) and people with low socio-economic status. Four themes were identified. These included the need for social responsiveness in clinical training organisations, justification and criticism of AAP, how clinical training agencies should participate in AAP and what constitutes an effective AAP for specialist medical and surgical training. CONCLUSIONS Affirmative action programmes have been effective at increasing numbers of ethnic minority medical school graduates but have not been used for specialist medical or surgical training selection. AAP achieve the best results when they are associated with a comprehensive programme of candidate preparation, support and mentorship beginning prior to application, and support and mentorship extending through training and subsequently into the post-training period as an independent professional. The overall aim of any AAP in medical or surgical training must be graduation of significant numbers of minority and Indigenous trainees into successful practice with appointment to faculty member and leadership positions.
Collapse
Affiliation(s)
- Jonathan Koea
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Maxine Ronald
- The Department of Surgery, Northland Base Hospital, Whangarei, New Zealand
| |
Collapse
|
12
|
Park B, Barazanchi A, Rahiri JL, Xia W, Taneja A, Hill AG. Patient Experiences of the Emergency Laparotomy Pathway: A Qualitative Study. World J Surg 2021; 45:1362-1369. [PMID: 33479849 DOI: 10.1007/s00268-020-05936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Emergency laparotomy (EL) is a commonly performed operation with high rates of morbidity and mortality. Despite a growing body of literature on outcomes from EL, there is sparse literature on the patient experience. The aim of this study is to capture the perspective of patients on their EL experience. Qualitative methodology is used as a platform to allow patients to express their personal experiences and ideas around the EL process. MATERIALS AND METHOD Participants were consented as a part of a large observational study, established across the three public teaching hospitals in Auckland, New Zealand. Patients who had an EL within the past 4 months were recruited. A recorded interview was conducted either face-to-face or over the telephone, using questions formulated from a previous systematic review on EL outcomes. Transcripts were transported to NVivo and thematically analysed by two reviewers. RESULTS Fifteen participants were interviewed. The majority of participants were female, New Zealand European and 65 or older. Five important themes were identified. Overall, participants expressed satisfaction with their interactions with hospital staff. However, they wanted more information about their condition, operation and what outcomes might occur. Participants also described post-operative priorities in the acute setting, as well as long-standing physical and emotional impacts. CONCLUSION This study provides a better understanding of what is important to patients during the EL process. This information is important when considering ways to improve care and communication with patients undergoing EL.
Collapse
Affiliation(s)
- Brittany Park
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand.
| | - Ahmed Barazanchi
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand
| | - Weisi Xia
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand
| | - Ashish Taneja
- Department of Surgery, Auckland Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Private Bag 93311, Otahuhu, Auckland, New Zealand
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| |
Collapse
|
13
|
Selak V, Rahiri JL, Jackson R, Harwood M. Acknowledging and acting on racism in the health sector in Aotearoa New Zealand. N Z Med J 2020; 133:7-13. [PMID: 32994633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Vanessa Selak
- Senior Lecturer, Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Jamie-Lee Rahiri
- Fellow in Medical Education, Department of Surgery, University of Auckland, Auckland
| | - Rod Jackson
- Professor, Epidemiology and Biostatistics, University of Auckland, Auckland
| | - Matire Harwood
- Associate Professor, General Practice and Primary Healthcare, University of Auckland, Auckland
| |
Collapse
|
14
|
Rahiri JL, Tuhoe J, Gillon A, MacCormick AD, Hill A, Harwood M. Enhancing responsiveness to Māori in a publicly funded bariatric service in Aotearoa New Zealand. ANZ J Surg 2019; 90:508-513. [PMID: 31840367 DOI: 10.1111/ans.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/09/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight loss and remission of obesity-related disease where all other interventions have been exhausted. This Kaupapa Māori qualitative study presents Māori perspectives of bariatric surgery from the largest public bariatric centre in NZ and offers solutions for enhancing bariatric service responsiveness to Māori. METHODS This qualitative study was informed by Kaupapa Māori methodology and involved a general inductive thematic analysis of 31 semi-structured interviews with Māori patients who had bariatric surgery at Counties Manukau Health in South Auckland, NZ. RESULTS Four key themes were identified following analysis: (i) Kaupapa Māori standards of health; (ii) bariatric mentors; (iii) bariatric psychologists; and (iv) community-integrated support. These themes offer four tangible solutions for optimizing bariatric pathways for Māori from the perspectives of Māori bariatric patients. CONCLUSION Kaupapa Māori, community-centred and greater non-surgeon aspects of bariatric supportive mechanisms comprise key areas of opportunity for public bariatric pathways in NZ. Surgical leadership is required to advance health equity and service responsiveness to Māori.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Jason Tuhoe
- Tokoroa Family Health, Tokoroa Hospital, Tokoroa, New Zealand
| | - Ashlea Gillon
- Department of General Practice and Primary Care, The University of Auckland, Auckland, New Zealand
| | - Andrew D MacCormick
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Andrew Hill
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
15
|
Rahiri JL, Tuhoe J, MacCormick AD, Hill AG, Harwood M. Exploring motivation for bariatric surgery among Indigenous Māori women. Obes Res Clin Pract 2019; 13:486-491. [PMID: 31591083 DOI: 10.1016/j.orcp.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Māori women in coming forward for bariatric surgery. METHODS Māori women who had bariatric surgery prior to December 31, 2014, were invited to participate in semi-structured interpersonal interviews. Kaupapa Māori research, an Indigenous Māori research methodology, informed this study. Interviews were recorded, transcribed and subject to inductive thematic analysis. RESULTS Twenty-nine Māori women participated in semi-structured interpersonal interviews. The majority of women reported that the presence of obesity-related disease alongside the desire for a better quality of life served as the greatest sources of motivation for having bariatric surgery. Whānau (family) were key for participants achieving the preoperative milestones needed to be accepted for bariatric surgery. Interpersonal experiences of fat-shaming and yo-yo dieting also impacted their choice to have surgery. CONCLUSION This study is one of the first to describe the motivations of Indigenous Māori women to have bariatric surgery. Our study conveys the importance of health, a desire to have a better quality of life and whānau in motivating Māori women to come forward for bariatric surgery.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand.
| | - Jason Tuhoe
- Department of General Practice and Primary Care, University of Auckland, Tāmaki Campus, Morrin Road, Glen Innes, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, University of Auckland, Tāmaki Campus, Morrin Road, Glen Innes, Auckland, New Zealand
| |
Collapse
|
16
|
Rahiri JL, Barazanchi A, Gillon A, MacCormick A, Harwood M, Hill A. Portrayal of bariatric surgery in the New Zealand print news media. ANZ J Surg 2019; 89:689-694. [PMID: 30845366 DOI: 10.1111/ans.15059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bariatric surgery has become topical in the media worldwide, influencing wider societal attitudes towards obesity and obesity management. This study aims to explore the media portrayal of bariatric surgery in all print news articles published in New Zealand (NZ) over a decade. METHODS An electronic search of two databases (Proquest Australia/NZ Newsstream and Newztext) and two NZ news media websites (Stuff and the NZ Herald) was performed to retrieve print news articles reporting stories, opinion pieces or editorials regarding bariatric surgery published between January 2007 to June 2017. Qualitative thematic analysis was performed on all included articles. RESULTS From January 2007 to December 2017, 252 articles related to bariatric surgery were published. Seven major themes emerged centred around barriers to accessing bariatric surgery, deficit attitudes towards obesity and social justice. These views were driven by articles that debated the limited number of publicly funded bariatric procedures offered in NZ. In addition, healthcare professionals used the media as a platform to challenge discriminatory attitudes towards obesity and bariatric surgery. CONCLUSION The NZ media is a powerful tool that still bolsters binary perspectives of obesity and bariatric surgery which may work against addressing the obesity epidemic.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Ahmed Barazanchi
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Ashlea Gillon
- Te Kupenga Hauora Māori, Tāmaki Campus, The University of Auckland, Auckland, New Zealand
| | - Andrew MacCormick
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, Tāmaki Campus, The University of Auckland, Auckland, New Zealand
| | - Andrew Hill
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
17
|
Rahiri JL, Coomarasamy C, Poole L, Hill AG, Poole G. Laparoscopic Ventral Hernia Repair in South Auckland, New Zealand-A Retrospective Review. J Surg Res 2018; 234:287-293. [PMID: 30527487 DOI: 10.1016/j.jss.2018.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/28/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ethnic disparities in surgical care and outcomes have been previously reported in studies for other surgical procedures. In addition, it has been reported that ethnic differences in postoperative analgesia exist. We aimed to determine ethnic disparities in postoperative outcomes, total opioid analgesia use, and complication rates of all patients who underwent a laparoscopic ventral hernia repair (LVHR) at our institution over a 3-y period. METHODS A retrospective review of all patients who underwent an LVHR at Counties Manukau Health from January 1, 2013, to December 31, 2015, was performed in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement. RESULTS A total of 267 ventral hernias were repaired in 254 patients at Counties Manukau Health over the study period, of which most were primary umbilical ventral hernias. The majority of patients in our cohort were New Zealand European and male. Major complications, as per the Clavien-Dindo classification grade 3 and above, were observed in six patients with no deaths (2.4%). There were no statistically significant ethnic disparities in length of stay, receipt of opioid analgesia, and rates of complication observed after linear regression modeling after adjustment for confounding factors. CONCLUSIONS Our study showed that the majority of patients who had a ventral hernia repaired at our institution were mostly New Zealand European and male. Although significant ethnic disparities in patient characteristics were observed, these were not associated with ethnic disparities in postoperative outcomes after an LVHR.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Otahuhu, Auckland, New Zealand.
| | - Christin Coomarasamy
- Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Lydia Poole
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Otahuhu, Auckland, New Zealand
| | - Garth Poole
- Department of Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| |
Collapse
|
18
|
Rahiri JL, Tuhoe J, MacCormick A, Hill A, Harwood M. A narrative review of bariatric surgery in Indigenous peoples. Obes Res Clin Pract 2018; 13:1-5. [PMID: 30477912 DOI: 10.1016/j.orcp.2018.11.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Indigenous peoples suffer high rates of obesity and obesity-related disease worldwide. Currently, bariatric surgery is the most effective intervention for severe obesity and obesity-related disease. The role bariatric surgery plays in alleviating the obesity burden amongst Indigenous peoples is unknown. We aimed to collate studies investigating bariatric surgery in Indigenous peoples and to provide a simple framework to use in future research surrounding this important issue. MATERIALS AND METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that investigated outcomes for Indigenous peoples at any point along the bariatric surgery journey were included. RESULTS Six articles were included in this review. Three studies investigated access to bariatric surgery and the remaining three studies investigated short to long-term outcomes following bariatric surgery. A narrative review was performed given study heterogeneity and quality of included studies. Indigenous peoples had lower access to bariatric surgery and in one study had greater weight loss in comparison to non-Indigenous peoples. CONCLUSION Despite a paucity of studies, it appears that there is emerging interest in investigating bariatric surgery among Indigenous peoples. We encourage those who seek to investigate this important issue at any point along the bariatric surgery journey, to do so using an equity-based approach.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 2025, New Zealand.
| | - Jason Tuhoe
- Tokoroa Family Health, Gate 3, Tokoroa Hospital, Tokoroa 3420, New Zealand
| | - Andrew MacCormick
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 2025, New Zealand
| | - Andrew Hill
- South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 2025, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, The University of Auckland, Tāmaki Campus, 261 Morrin Rd, St Johns, Auckland 1072, New Zealand
| |
Collapse
|
19
|
Barazanchi AW, MacFater W, Rahiri JL, Tutone SD, Hill AG, Joshi G. Evidence-Based Management of Pain after Laparoscopic Cholecystectomy: A PROSPECT Review. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Rahiri JL, Barazanchi A, Furukawa S, MacCormick AD, Harwood M, Hill AG. Using Google Trends to explore the New Zealand public's interest in bariatric surgery. ANZ J Surg 2018; 88:1274-1278. [DOI: 10.1111/ans.14772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/06/2018] [Accepted: 06/13/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus; The University of Auckland; Auckland New Zealand
| | - Ahmed Barazanchi
- Department of Surgery, South Auckland Clinical Campus; The University of Auckland; Auckland New Zealand
| | - Sai Furukawa
- Department of Native Hawaiian Health; John A. Burns School of Medicine, University of Hawaii; Honolulu Hawaii USA
| | - Andrew D. MacCormick
- Department of Surgery, South Auckland Clinical Campus; The University of Auckland; Auckland New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, Tāmaki Campus; The University of Auckland; Auckland New Zealand
| | - Andrew G. Hill
- Department of Surgery, South Auckland Clinical Campus; The University of Auckland; Auckland New Zealand
| |
Collapse
|
21
|
Rahiri JL, Gillon A, Furukawa S, MacCormick AD, Hill AG, Harwood MLN. Media portrayal of Māori and bariatric surgery in Aotearoa/New Zealand. N Z Med J 2018; 131:72-80. [PMID: 30048435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Media constructs in Aotearoa, New Zealand naturalise the dominant Western culture. Conversely, mainstream news about Māori is rare and prioritises negative stereotypical constructs that are often centred on Māori as economic threats via resource control and political activism. These narratives influence continued discrimination against Māori in New Zealand. Media representations of bariatric surgery in New Zealand are not widely understood. We explored the portrayal of Māori and bariatric surgery in print and online news media articles in New Zealand using an inductive approach to thematic analysis. METHOD An electronic search of two databases (Proquest Australia/ New Zealand Newsstream and Newztext) and two New Zealand news media websites (Stuff and the New Zealand Herald) was performed to retrieve news articles reporting stories, opinion pieces or editorials concerning Māori and bariatric surgery published between January 2007 to June 2017. Articles were scored using a five-point scale to assess the level of reporting as either very negative, negative, neutral, positive or very positive. Included articles were then subjected to inductive thematic analysis using the NVIVO 11 to identify and explore common themes surrounding Māori and bariatric surgery. RESULTS Of 246 articles related to bariatric surgery over the 10-year study period, 31 (13%) were representative of Māori. Articles were scored as 'neutral' to 'positive' with a mean reporting score of 3.7 (Kappa score of 0.72 [95% CI, 0.66-0.78, p<0.0001]). Five main themes were identified, these were: Attitudes towards bariatric surgery; complexity of obesity and weight loss; access to bariatric surgery; Māori advocacy and framing of Māori. Of the five themes, access to bariatric surgery and attitudes towards bariatric surgery were most prevalent. Māori advocacy was another common theme that arose largely due to the support of public funding of bariatric surgery championed by Dame Tariana Turia. Aside from this, narratives describing equity of bariatric surgery provision and equitable outcomes following bariatric surgery for Māori were sparse. CONCLUSION There was limited reporting on Māori health inequalities and equitable access to publicly funded bariatric surgery in New Zealand. We argue that this lack of coverage may work against addressing disparities in obesity prevalence and access to publicly funded bariatric surgery for Māori in New Zealand.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Research Fellow, Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland
| | - Ashlea Gillon
- Research Fellow, Te Kupenga Hauora Māori, Tāmaki Campus, The University of Auckland, Auckland
| | - Sai Furukawa
- Medical Student, Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i
| | - Andrew Donald MacCormick
- Senior Lecturer, Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland
| | - Andrew Graham Hill
- Professor of Surgery, Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland
| | | |
Collapse
|
22
|
Rahiri JL, Alexander Z, Harwood M, Koea J, Hill AG. Systematic review of disparities in surgical care for Māori in New Zealand. ANZ J Surg 2017; 88:683-689. [PMID: 29150888 DOI: 10.1111/ans.14310] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may occur and highlight some of the potential contributing factors, over all surgical specialties, between Māori and NZE adults in NZ. METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A series of electronic searches were performed in Medline, Embase, PubMed and CINAHL. RESULTS Ten studies met the inclusion criteria. All studies employed a range of indicators for surgical care including receipt of surgery following diagnosis, delays to treatment and post-operative morbidity and mortality. Disparities in the receipt of surgical treatment for several cancers were observed for Māori and remained after adjustment for socioeconomic variables and extent of disease. Māori were more likely to experience delays in treatment and referral to other medical specialties involved in their care. CONCLUSION Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Zanazir Alexander
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| |
Collapse
|
23
|
Rahiri JL, Lauti M, Harwood M, MacCormick AD, Hill AG. Ethnic disparities in rates of publicly funded bariatric surgery in New Zealand (2009-2014). ANZ J Surg 2017; 88:E366-E369. [PMID: 29044970 DOI: 10.1111/ans.14220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Publicly funded bariatric surgery in New Zealand (NZ) is steadily on the rise to meet the obesity epidemic. Ethnic disparities in obesity rates exist in NZ with Māori and Pacific people having three to five times higher rates than all other ethnic groups within NZ. Ethnic disparities in rates of bariatric surgery have been reported internationally. This research sought to describe rates of publically funded bariatric surgery by self-identified ethnicity in NZ. METHODS Using reported census and hospitalization discharge data from Statistics NZ and the NZ Ministry of Health, we calculated estimate rates of publicly funded bariatric surgery in the morbidly obese population from June 2009 to July 2014. RESULTS The average number of publicly funded bariatric procedures performed per 1000 morbidly obese patients from June 2009 to July 2014 was 3.0 for European, 1.4 for Māori and 0.7 for Pacific ethnicities. CONCLUSION While these data should be interpreted cautiously due to data limitations, the estimated rates may indicate that bariatric services are currently being provided inequitably across the major ethnic groups within NZ. We suggest that further studies should be performed to explore potential patient, healthcare provider and system-level factors that may contribute to ethnic disparities in the rates of publicly funded bariatric surgery in NZ.
Collapse
Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Mel Lauti
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, Tamaki Campus, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
24
|
MacFater WS, Rahiri JL, Lauti M, Su'a B, Hill AG. Intravenous lignocaine in colorectal surgery: a systematic review. ANZ J Surg 2017; 87:879-885. [PMID: 28677829 DOI: 10.1111/ans.14084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Colorectal surgery leads to morbidity during recovery including pain and fatigue. Intravenous (IV) lignocaine (IVL) has both analgesic and anti-inflammatory effects that may improve post-operative pain and recovery. The aim of this review is to compare the effectiveness of IVL to other perioperative analgesia regimens for reducing pain and opioid consumption following colorectal surgery. METHODS Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a literature search was conducted to identify randomized clinical trials that compared IVL with IV placebo or epidural anaesthesia in open or laparoscopic colorectal surgery. The primary outcomes were opioid requirements and pain scores assessed by visual analogue score. Data were entered into pre-designed electronic spreadsheets. RESULTS The literature search identified 2707 studies. A total of nine randomized clinical trials met the inclusion criteria. Five studies investigated IVL compared with IV placebo and four studies investigated IVL compared with epidural anaesthesia. Two out of the five studies comparing IVL and placebo showed statistically significant reductions in opioid consumption with IVL. There was a variable degree of improvement in pain scores when IVL was compared with epidural. Two studies showed a significant difference, with lower opioid consumption and pain scores in the epidural group. Laparoscopic and open procedures could not be compared between the IVL and placebo group. CONCLUSION IVL has shown limited benefit towards reducing early pain and morphine consumption when compared with placebo in colorectal surgery. However, IVL did not show any significant reduction in pain or opioid consumption when compared with epidural. Further research investigating IVL combined with intraperitoneal local anaesthetic is warranted.
Collapse
Affiliation(s)
- Wiremu S MacFater
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Melanie Lauti
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Bruce Su'a
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Auckland, New Zealand
| |
Collapse
|
25
|
Su'a BU, Mikaere HL, Rahiri JL, Bissett IB, Hill AG. Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery. Br J Surg 2017; 104:503-512. [PMID: 28295255 DOI: 10.1002/bjs.10487] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) following colorectal surgery can be difficult to diagnose owing to varying clinical presentations. This systematic review aimed to assess biomarkers as potential diagnostic tests for preclinical detection of AL. METHODS A comprehensive literature review was conducted according to PRISMA guidelines. All published studies evaluating biomarkers, both systemic and peritoneal, in the context of AL following colorectal surgery were included. Studies were sought in three electronic databases (MEDLINE, PubMed and Embase) from January 1990 to June 2016. RESULTS Thirty-six studies evaluated 51 different biomarkers in the context of AL after colorectal surgery. Biomarkers included markers of ischaemia and inflammation, and microbiological markers, and were measured in both peritoneal drain fluid and the systemic circulation. The most commonly evaluated peritoneal drain fluid biomarkers were interleukin (IL) 6, IL-10 and tumour necrosis factor. Significantly raised drain levels in the early postoperative period were reported to be associated with the development of AL. C-reactive protein, procalcitonin and leucocytes were the most commonly evaluated systemic biomarkers with significant negative and positive predictive values. Associated area under the curve values ranged from 0·508 to 0·960. CONCLUSION Peritoneal drain fluid and systemic biomarkers are poor predictors of AL after colorectal surgery. Combinations of these biomarkers showed improvement in predictive accuracy.
Collapse
Affiliation(s)
- B U Su'a
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - H L Mikaere
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - J L Rahiri
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| | - I B Bissett
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - A G Hill
- Department of Surgery, South Auckland Clinical Campus, Middlemore Hospital, University of Auckland, Auckland, New Zealand.,Department of General Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| |
Collapse
|
26
|
Abstract
UNLABELLED Introduction Systematic reviews report intraperitoneal local anesthetic (IPLA) effective in adults but until now no review has addressed IPLA in children. The objective of this review was to answer the question, does IPLA compared with control reduce pain after pediatric abdominal surgery. Materials and Methods Data sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray. STUDY SELECTION Independent duplicate searching for randomized controlled trials of IPLA versus no IPLA/placebo in children ≤ 18 years of age, reporting pain, or opioid use outcomes. DATA EXTRACTION Independent duplicate data extraction and quality assessment using standardized fields. Results The selection process uncovered three eligible published trials and one unpublished study, all in laparoscopy surgery. Qualitative synthesis suggested that IPLA may reduce pain scores, opioid use, time to first opioid, and the need for rescue analgesia, with no effect on hospital stay. Risk of bias was significant. Conclusions IPLA appears promising in pediatric surgery. The high absorptive capacity of the peritoneum and high peritoneal surface area to volume ratio in children presents a dose limitation. In comparison to adult surgery, IPLA has been understudied in pediatric surgery.
Collapse
Affiliation(s)
- James K Hamill
- Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Andrew Liley
- Department of Anaesthesia, Starship Children's Health, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
27
|
Hamill JK, Rahiri JL, Gunaratna G, Hill AG. Interventions to optimize recovery after laparoscopic appendectomy: a scoping review. Surg Endosc 2016; 31:2357-2365. [PMID: 27752812 DOI: 10.1007/s00464-016-5274-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND No enhanced recovery after surgery protocol has been published for laparoscopic appendectomy. This was a review of evidence-based interventions that could optimize recovery after appendectomy. METHODS Interventions for the review Clinical pathway, fast-track or enhanced recovery protocols; needlescopic approach; single incision laparoscopic (SIL) approach; natural orifice transluminal endoscopic surgery (NOTES); regional nerve blocks; intraperitoneal local anaesthetic (IPLA); drains. Data sources MEDLINE, EMBASE, the Cochrane Library, and the Web of Science Core Collection. Study eligibility criteria Randomized controlled trial (RCT); prospective evaluation with historical controls for studies assessing clinical pathways/protocols. Participants People undergoing laparoscopic appendectomy for acute appendicitis. Study appraisal and synthesis methods Meta-analysis, random effects model. RESULTS Clinical pathways for laparoscopic appendectomy were safe in selected patients, but may be associated with a higher readmission rate. Needlescopic surgery offered no recovery advantage over traditional laparoscopic appendectomy. SIL afforded no recovery advantage over conventional laparoscopic surgery, but may increase operative time in children. The search found no RCT on NOTES appendectomy. Transversus abdominis plane blocks did not significantly reduce pain after laparoscopic appendectomy. IPLA should be considered in laparoscopic appendectomy; studies in paediatric surgery are needed. The search found no RCT on the use of drains in appendectomy. CONCLUSIONS This review identified gaps in the literature on optimizing recovery after laparoscopic appendectomy and found the need for more randomized controlled trials on regional anaesthesia and intraperitoneal local anaesthesia in children.
Collapse
Affiliation(s)
- James K Hamill
- Department of Surgery, Starship Hospital, Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand. .,Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | - Gamage Gunaratna
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| |
Collapse
|
28
|
Yule MS, Krishna S, Rahiri JL, Hill AG. Trampoline-associated injuries are more common in children in spring. N Z Med J 2016; 129:37-43. [PMID: 27355227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIMS Trampoline use is a popular pastime amongst children in New Zealand, and has many advantages for child development. However, recent reports claim that trampoline-associated injuries are still highly prevalent. In order to help prevent these injuries in the future, this study aims to provide more up-to-date epidemiological information in children, with emphasis on the time of year that injuries most commonly occur. METHODS A retrospective review was carried out utilising a prospective maintained trauma database. The database was searched electronically for injuries involving trampolines in children aged 0-15 years. Patient demographics and information regarding month of injury, injury type and management were extracted. RESULTS There were 344 admissions to hospital for trampoline-related injuries between June 2000 and January 2015. Injuries were uncommon in winter, but rose in spring and summer. Fracture of the radius and/or ulna was the most common injury (34.0%), followed by humeral fracture (32.0%). CONCLUSION The peak incidence of trampoline-related injuries occurred around the beginning of spring daylight savings time each year. This could therefore prove an opportune time to remind children and parents about trampoline safety at the same time as daylight savings reminders.
Collapse
Affiliation(s)
| | - Sanjeev Krishna
- South Auckland Clinical Campus, Level 2, North Wing, Esme Green Building, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
| | | | | |
Collapse
|
29
|
Hamill JK, Rahiri JL, Liley A, Hill AG. Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials. Paediatr Anaesth 2016; 26:363-71. [PMID: 26846889 DOI: 10.1111/pan.12855] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The role of rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks in pediatric surgery has not been well established. OBJECTIVE We aimed to determine if RSB and TAP blocks decrease postoperative pain and improve recovery in children. DATA SOURCES Duplicate searching of MEDLINE, EMBASE, Cochrane, Web of Science, and trial registries databases by two reviewers. STUDY SELECTION Included were randomized trials in children on RSB or TAP block in abdominal operations, excluding inguinal procedures. DATA EXTRACTION Independent duplicate data extraction and quality assessment using a standardized form. RESULTS Ten trials met inclusion criteria (n = 599), RSB in five and TAP block in five. A linear mixed effects model on patient level data from three trials showed nerve blocks lowered morphine requirements 6-8 h after surgery, -0.03 mg · kg(-1) (95% CI -0.05, -0.002). Pooled analysis of summary data showed nerve blocks lowered 0-10 scale pain scores immediately after the operation, -0.7 (95% CI -1.3, -0.1); lowered 4-16 scale pain scores, -2.0 (95% CI -2.3, -1.7); and delayed the time to first rescue analgesia, 17 min (95% CI 1.3, 33). Quality assessment showed some studies at moderate to high risk of bias. CONCLUSION Abdominal wall blocks reduce pain and opiate use in children. We advise cautious interpretation of the results given the heterogeneity of studies.
Collapse
Affiliation(s)
- James K Hamill
- Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrew Liley
- Department of Anesthesia, Paediatric Pain Team and Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Andrew G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|