An Equity Review of Emergency Laparotomy At Wellington Regional Hospital
Authors List
Haimona, M., CCDHB, Wellington, New Zealand
Introduction: Perioperative Mortality Review Committee (POMRC) released the Eighth Report focusing on mortality following emergency laparotomies(Quality & Commission, n.d.). This report identified multiple inequities including a higher mortality rate for Māori compared to non-Māori. Furthermore, Māori have higher post-operative mortality across a broad range of procedures compared to Europeans(Gurney et al., 2021).
Aims: The aim of this project was to determine 30-day mortality of Māori compared to non-Māori having emergency laparotomies at Wellington Regional Hospital.
Methods: In total, 307 eligible cases were included in this study and analysed for differences based on ethnicity. Primary outcome was 30-day mortality. Secondary outcomes included Emergency Department (ED) admission prior, pre-operative American Society of Anaesthesiologists (ASA) score, post-operative complications, Intensive Care Unit (ICU) admission post operatively, length of stay and pre-operative NZrisk score.
Results: 34 (11%) of these cases were Maori cases compared to 273(88%) non-Maori cases. On average Māori were younger. There was no difference in mortality rate, complication rate, or length of stay associated with ethnicity. However, Māori are more likely to have a higher ASA score. Interestingly, the preoperative NZrisk score was not significantly different between Māori and non-Māori. Lastly, this study identified that Māori were less likely to have an ED admission compared to non-Māori.
Conclusion: This study showed that there is no difference in mortality rate, complication rate, or length of stay associated with ethnicity. However, Māori patients are younger and have higher ASA scores which are strongly associated with mortality.
Reference:
Gurney, J., Mcleod, M., Stanley, J., Sarfati, D., Campbell, D., Davies, C., Dennett, E., Himona, P., Jackson, S., Ongley, D., Robson, B., Rumball-Smith, J., Signal, V., Stairmand, J., Thomas, C., & Koea, J. (2021). Disparities in post-operative mortality between Māori and non-Indigenous ethnic groups in New Zealand. 134, 1542. www.nzma.org.nz/journal
Quality, H., & Commission, S. (n.d.). Perioperative Mortality in New Zealand | Te Mate Whai Muri mai i te Poka ki Aotearoa. www.hqsc.govt.nz
