Hon Peter Dunne
Associate Minister of Health

15 June 2015

Perioperative mortality report’s new areas help New Zealand remain world leader

Associate Health Minister Peter Dunne is welcoming today’s release of the fourth annual Perioperative Mortality Review Committee’s (POMRC) report.

Additional operative procedures have been added to the report for the first time: coronary artery bypass grafts (CABG), percutaneous transluminal coronary angioplasty (PCTA), bariatric surgery and severe postoperative infections.

It also includes for the first time patients with American Society of Anaesthesiologists (ASA) scores over four or five – a rating system used to assess a patient’s overall physical health before undertaking surgery. ASA scores of four or five represent those most at risk of dying without a procedure.

Mr Dunne says New Zealand’s surgical teams have a high level of skill.

“Being able to review real hospital and patient data ensures any issues are quickly identified so high-quality services can continue to be delivered to New Zealanders.

“In May of this year, at a regional meeting of the Lancet Commission on Global Surgery, New Zealand was mentioned as having the best perioperative mortality data in the world, and we should be very proud of this.

“The inclusion of the additional areas in this report is welcome as it allows New Zealand to continue to set this standard, while also improving our understanding of our own postoperative care.”

The POMRC will continue to review these five areas as it begins to develop principles which can be adopted for local perioperative mortality review systems across the country.

Mr Dunne spoke at the third annual Perioperative Mortality Review Committee workshop in Auckland this morning.

SPEECH:
I welcome the opportunity to be here today to speak at the 3rd annual Perioperative Mortality Review Committee workshop (or Pomrick for short, as I’m advised it is referred to).
I would like to thank Dr Leona Wilson for her welcome.
I would also like to thank all the members of the POMRC and the Commission for their tireless efforts to ensure that New Zealand offers the best perioperative care in the world.
Quality and safety in health and disability services is a priority for this Government.
This Government established the Health Quality & Safety Commission to provide leadership across health services on quality and safety issues.
The POMRC was established in 2010. It is a statutory committee of the Health Quality & Safety Commission that reviews perioperative deaths, and then uses the findings from those reviews to develop evidence-based recommendations on how to make surgery safer.
As Professor Alan Merry is likely to tell us next, the lessons learnt from the work of the POMRC contribute significantly to improving the quality and safety of New Zealand’s perioperative care system.
The work of the POMRC aligns with the Government’s current focus on improving perioperative care.
As you may be aware, an extra $98 million has been invested in Budget 2015 to provide more New Zealanders with timely elective surgery, more orthopaedic and general surgeries, and to create early intervention orthopaedic teams.
This $98 million includes $48 million over four years for elective surgeries.
Access to elective surgery is a top priority for the Government because elective surgery makes a real difference to patients and their families – it reduces pain, increases independence, and improves quality of life.
The number of patients receiving elective surgery has increased from 118,000 in 2007/08 to 162,000 in 2013/14.
That’s 44,000 more operations - a 37 per cent increase.
This funding boost will help reduce wait times for elective surgery and provide for more elective surgeries.
An additional $44 million is being invested over three years to support extra orthopaedic and general surgeries, and $6 million is being invested to create early intervention orthopaedic teams.
These community-based, multi-disciplinary early intervention teams will support diagnosis and management of orthopaedic conditions, which will help improve patients’ quality of life and avoid unnecessary hospital visits.
This increase in elective surgeries has perhaps also added to the significance of the POMRC’s work.
I would like to congratulate the POMRC on the production of this fourth report, which looks at data analysed over the years 2008 to 2012.

One highlight of this report is that some of the clinical areas presented in previous reports have been extended for the 2008-2012 time period, meaning comparisons can now be made from 2005 to 2012.

This data shows that perioperative mortality rates have modestly declined for low-risk anaesthesia.

Another highlight of this POMRC report is the consideration of several different World Health Organization (WHO) metrics for surgical care.
The first set of metrics compared two different WHO analytical methods, one based on general anaesthesia and the other based on surgical specialty admissions.

The second set of metrics examined the number of surgical procedures for the 10 most frequent procedures in NZ, and the proportion of deaths after surgery for the 10 most frequent procedures in NZ.

This ongoing work will provide assurance that the POMRC data is robust and reliable, and it will enable the POMRC to make comparisons with New Zealand perioperative mortality across countries and jurisdictions.

It is encouraging to see that five new areas of clinical importance have been included in this year’s report, and a summary of rates for clinical areas from previous reports has also been included as part of the POMRC’s approach to continued long-term surveillance of perioperative mortality.

Being able to see real hospital data and real patient data from New Zealand is of huge value and adds a large amount of knowledge and information for both clinicians and patients.

The report outlines several recommendations developed by the POMRC informed by the data presented.

The report also reminds us that there is still work to be done, however, particularly in ensuring that all New Zealanders receive the best perioperative care.

For instance, the report finds that from 2008-2012 perioperative mortality rates following both acute and elective/waiting list admissions for coronary artery bypass graft (CABG) were higher for Maori compared to Europeans.

This finding reminds us that higher perioperative mortality rates are driven by both the quality of perioperative care and also timely access to surgical care.
Since the POMRC’s inaugural report in 2012, it has focused on establishing an integrated whole-of-healthcare system approach for the identification and reporting of perioperative mortality.

In May of this year, at a regional meeting of the Lancet Commission on Global Surgery, it was mentioned that New Zealand has by far the best data on perioperative mortality in the world.

We are fortunate to be world leaders in this area but, rather than be complacent, we must continuously strive to collect better data on perioperative mortality.

The work with the Lancet group is of great value as it allows good international comparisons.

The data in this report is generated from the National Minimum Data Set (NMDS) and the National Mortality Collection (NMC), but there are data limitations associated with coding accuracy and data completeness.

And, while the Ministry of Health is unable to estimate the extent, there is likely to be an undercount of some private hospital events.

It is important that all providers, both public and private, fully contribute their health care data.

The POMRC continues to explore the use of World Health Organisation metrics as standardised indicators for surgical care in New Zealand.

The POMRC also continues to work with other bodies, such as the Lancet Commission on Global Surgery and the New Zealand Joint Registry, to better understand perioperative mortality and provide information on the safety of surgery and anaesthesia in New Zealand.

The theme for today’s workshop is: Mortality review – making it work for you and your patients.

The POMRC is currently working to identify examples of best local perioperative mortality review practice throughout New Zealand, and will then develop a set of principles for local perioperative mortality review systems that can be shared nationwide.

Today’s workshop, being held in Auckland for the first time, is an excellent opportunity for all those involved in perioperative care, and in the review of perioperative mortality, to come together to share knowledge and ideas.

It is a privilege to have both international and national speakers to the workshop, as well as the knowledge that all those present will bring.
We are particularly grateful for Professor David Watters and Professor Clifford Ko, who have traveled from Australia and the United States, respectively, to attend this conference.

Professor Watters is the current President of the Royal Australasian College of Surgeons and Professor Ko is the Director of the Division of Research and Optimal Patient Care at the American College of Surgeons.

There is significant national and international expertise in this room.

As such, this workshop offers a wonderful opportunity for discussing perioperative mortality review in New Zealand, as well as quality improvement in association with perioperative care more broadly.

I thank you for the contributions you make in this important area and I urge you to make the most of this excellent opportunity.

I wish you all the very best for a productive and informative day.

ends

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