Poor more likely to die after surgery, report finds

Those in the most deprived areas are more likely to die after surgery, a report has found. Photo / File

Poor people are more likely to die within 30 days of surgery than patients from wealthy areas, an independent review has found.

The disparity in mortality rates and the number of emergency admissions, which were almost twice as likely for the poorest patients, was described as "glaring" and in need of investigation by one of the authors of the Perioperative Mortality Review Committee.

The committee advises the Health Quality & Safety Commission on how to reduce the number of surgery-related deaths in New Zealand. It reviews anaesthesia- and surgery-related deaths that happen within 30 days of an operation.

Associate Health Minister Peter Dunne this afternoon described the report as "concerning".

The Health Quality and Safety Commission comes under Dunne's areas of responsibility.

Dunne is overseas as part of Prime Minister Bill English's Pacific Islands mission this week, and sent the Herald a statement about the report.

"The report is concerning and confirms what we have suspected.

"What it underscores is the need for greater emphasis on primary programmes for our most vulnerable to minimise their need for secondary and tertiary treatment."

The report released today is the committee's sixth and contains a chapter focusing on mortality and socioeconomic deprivation.

It revealed that people living in the most deprived areas had a higher rate of perioperative mortality - at 0.63 per cent - than people living in the least deprived areas, where mortality was 0.39 per cent.

The national mortality rate was 0.54 per cent, with 6085 deaths from 1,117,908
admissions.

The poorest patients were also almost twice as likely as the other group to have emergency surgery, and also had 14 per cent more elective operations, the report found.

When adjusting for the effects of other clinical and sociodemographic factors, such as age, ethnicity and other illnesses, those in the most deprived areas had a 1.18 times greater risk of mortality after elective surgery than those in the least deprived areas.

For acute surgery, this increased to 1.46 times.

Committee chairwoman Dr Leona Wilson said all deaths after surgery were a tragedy, but the findings were "glaring".

"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 were a number of reasons it may be happening, including difficulty accessing or affording healthcare, she said.

But the committee believed there was no reason the disparities should exist and wanted urgent work to reduce them.

The report recommended research be done into socioeconomic and ethnic inequities in perioperative mortality, and emergency versus elective surgery rates, she said.

The committee also wanted district health boards, with the support of the Ministry of Health, to investigate programmes to increase access to primary care and medical and surgical specialists.

BY THE NUMBERS
● Among the most deprived population, there were 259,609 admissions for surgery between 2009 and 2013, with 1647 patients dying within 30 days of surgery

● Among the least deprived population, there were 196,950 admissions for surgery between 2009 and 2013, with 768 deaths

● Nationally, there were 1,117,908 admissions and 6085 deaths - a mortality rate of 0.54

● The number of elective admissions for the most deprived was 175,921, 14 per cent higher than the least deprived

● The number of acute admissions for the most deprived was a massive 95 per cent increase of those for the least deprived - 83,688 versus 42,748

● The most deprived also had a higher percentage of acute admissions compared to elective, with 32.2 per cent compared to 21.7 per cent for the least deprived.