Report Finds "Unacceptable Discrepancies" in Death Rates
The Perioperative Mortality Review Committee (POMRC) has identified what it says are unacceptable discrepancies in the mortality rates for New Zealand’s most deprived populations.
The POMRC reviews deaths related to surgery and anaesthesia that occur within 30 days of an operation. It advises the Health Quality & Safety Commission on how to reduce these deaths and makes recommendations to make sur-gery safer for patients.
Its sixth report, released today, contains a special chapter focusing on perioperative mortality and socioeconomic deprivation.
Findings include that people living in the most deprived areas (areas with greatest poverty) had a higher rate of peri-operative mortality (0.63%) than people living in the least deprived areas (0.39%). The poorest patients were also almost twice as likely as the other group to have emergency surgery, and also had 14% more elective (waiting list) operations.
• Among the most deprived (quintile 5) population, there were 259,609 admissions for surgery in the 2009–2013 period
• 1,647 of these patients died within 30 days of surgery, a 0.64 percent mortality rate.
• Among the least deprived (quintile 1) population, there were 196,950 admissions for surgery in the 2009–2013 period
• 768 of these patients died within 30 days of surgery, a 0.39 percent mortality rate.
• Nationally, there were 1,117,908 admissions and 6,085 deaths, a 0.54 percent mortality rate
• While the number of elective admissions for the most deprived (175,921) was 14 percent higher than the least deprived (154,202), the number of acute admissions was far higher, with 83,688 for the most deprived and 42,748 for the least deprived – a 95 percent increase
• The most deprived also had a higher percentage of acute admissions compared to elective, with 32.2 percent compared to 21.7 percent for the least deprived
• When adjusting for the effects of other sociodemographic (eg, age and ethnicity) and clinical factors (eg, other illnesses), those in the most deprived areas had a 1.18 times greater risk of mor-tality after elective surgery than those in the least deprived areas. For acute surgery, this increased to 1.46 times.
‘Whenever we see a death after surgery it represents a tragic loss of life,’ says POMRC Chair Dr Leona Wilson.
‘But this disparity in mortality rates and number of emergency admissions is glaring and we need to look into why it exists, as every person in New Zealand has the right to expect the same standard of health care regardless of their socioeconomic situation.
‘There are a number of reasons this may be occurring, including difficulty accessing or affording health care – it may be more difficult for those in the most deprived areas to travel to the doctor or get leave for the care they need for example. However, the POMRC believes there is no reason these disparities should exist and work needs to be done urgently in the sector to reduce them.’
The POMRC’s report makes a number of recommendations calling for research into socioeconomic and ethnic inequities in perioperative mortality, and emergency versus elective surgery rates,’ says Dr Wilson.
‘This research is important, as it will allow the New Zealand health sector to understand why these disparities exist and what can be done to reduce them.’
The POMRC is also recommending that District Health Boards, with the support of the Ministry of Health, investigate programmes to increase access to both primary care and medical and surgical specialists.