Measuring the quality of surgical care provision to Aboriginal and Torres Strait Islander patients

Self Cite

Background: There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self-reported unemployment and neighbourhood level socioeconomic status in Australia. Methods: A retrospective administrative data review was conducted at a tertiary care centre over a 10-year period (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed. Results: 106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50-2.82), OR 1.37 (1.15-1.64)), all complications ), OR 1.21 (1.14-1.28)), failure to rescue )) and return to theatre , OR 1.24 (1.14-1.36)) (P < 0.005 for all). Conclusions: Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.

Section: Discussionmentioning

confidence: 99%

Disparities in surgical outcomes for low socioeconomic status patients in Australia

Jager

Gunnarsson

2022

Self Cite

“…While there is no specific research surrounding morbidity in EL for Aboriginal and Torres Strait Islander people, there is evidence of inferior perioperative outcomes in many surgical settings. 44 The National Emergency Laparotomy Audit (NELA) reports from the UK provide an important snapshot into changes to mortality rates over time. In 2014, the reported 30-day mortality rate was 11.8% 4 ; however in 2019, 30-day mortality rate had fallen to 9.6%.…”

Section: Discussionmentioning

confidence: 99%

New Zealand and Australia emergency laparotomy mortality rates compare favourably to international outcomes: a systematic review

Fagan

Barazanchi

Coulter

et al. 2021

Background: Almost 20 000 people undergo an emergency laparotomy each year in New Zealand and Australia. Common indications include small and large bowel obstruction, and intestinal perforation. Considered a high-risk procedure, emergency laparotomy is associated with significantly high morbidity and mortality. The aim of this review was to identify and compare 30-day, 90-day and 1-year mortality rates following emergency laparotomy in New Zealand and Australia. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic searches were performed in Medline, Embase, PubMed and Scopus in April 2020. Results: Thirty-three papers met the inclusion criteria. Studies ranged in size from 58 to 75 280 patients. Weighted mean 30-day mortality was 8.40% (8.39-8.41). Mortality rates increased with longer postoperative follow up with 90-day weighted mortality rate of 14. 14% (14.13-14.15) and the weighted mortality rate at 1 year of 24.60% (24.56-24.66). There was significant variability in mortality rates between countries. Conclusion: There is a wide variability of 30-day, 90-day and 1-year mortality rates internationally. Lowering postoperative mortality rates following emergency laparotomy through quality improvement initiatives could result in up to 120 lives in New Zealand and over 250 lives in Australia being saved each year. The continued work of the Australian and New Zealand Emergency Laparotomy Audit -Quality Improvement is crucial to improving emergency laparotomy mortality rates further in New Zealand and Australia.

“…While Aboriginal people are more likely to be hospitalized than non‐Aboriginal Australians, the reverse is true for admission to hospital for surgical procedures 54–56 . Aboriginal people are half as likely to be admitted for an elective surgical procedure compared to non‐Aboriginal Australians but twice as likely to be admitted for emergency surgery and spend longer on surgical waiting lists 5,54,56,57 . This compounds an already overburdened public elective surgery service 58 .…”

Section: The Pathway To High‐quality Surgical Carementioning

confidence: 99%

“…Aboriginal people that undergo surgical treatment, are younger, present at more advanced stages of disease and experience higher rates of post‐operative morbidity and mortality 5,6,40,62,63 . These poor health outcomes can reinforce distrust in clinicians and services and further hamper a willingness to seek health care.…”

Section: The Pathway To High‐quality Surgical Carementioning

confidence: 99%

“…Often Aboriginal people experience systematic barriers to accessing appropriate, affordable and high‐quality health care including elective surgery 3,4 . With the exception of more recent work, 5,6 little research has examined disparities in surgical care and outcomes that Aboriginal patients experience. Timely access to equitable, high‐quality surgical care is an integral component of Australia's universal health care system 7 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Addressing surgical inequity for Aboriginal and Torres Strait Islander people in Australia's universal health care system: a call to action

O’Brien

Bunzli

Lin

et al. 2021

Aboriginal and Torres Strait Islander people continue to experience health inequity within the Australian health care system. Little research has examined how disparities in surgical care access and outcomes contribute to Aboriginal health. In this narrative review and call to action, we discuss five care points along the journey to high‐quality surgical care: health care seeking, primary health care services, specialist services, surgery and surgical outcomes. We highlight barriers and disparities that exist along this journey, drawing examples from the field of joint replacement surgery. Finally, we present opportunities for change at the health system, health service and clinician level, calling upon researchers, clinicians and policy makers to confront the surgical disparities experienced by Aboriginal and Torres Strait Islander people.