Department of Public Health, University of Otago, Wellington, New Zealand.
Auckland District Health Board, Auckland, New Zealand.
ANZ J Surg. 2022 May;92(5):1015-1025. doi: 10.1111/ans.17510. Epub 2022 Apr 20.
There is a growing body of evidence that access to best practice perioperative care varies within our population. In this study, we use national-level data to begin to address gaps in our understanding of regional variation in post-operative outcomes within New Zealand.
Using National Collections data, we examined all inpatient procedures in New Zealand public hospitals between 2005 and 2017 (859 171 acute, 2 276 986 elective/waiting list), and identified deaths within 30 days. We calculated crude and adjusted rates per 100 procedures for the 20 district health boards (DHBs), both for the total population and stratified by ethnicity (Māori/European). Odds ratios comparing the risk of post-operative mortality between Māori and European patients were calculated using crude and adjusted Poisson regression models.
We observed regional variations in post-operative mortality outcomes. Māori, compared to European, patients experienced higher post-operative mortality rates in several DHBs, with a trend to higher mortality in almost all DHBs. Regional variation in patterns of age, procedure, deprivation and comorbidity (in particular) largely drives regional variation in post-operative mortality, although variation persists in some regions even after adjusting for these factors. Inequitable outcomes for Māori also persist in several regions despite adjustment for multiple factors, particularly in the elective setting.
The persistence of variation and ethnic disparities in spite of adjustment for confounding and mediating factors suggests that multiple regions require additional resource and support to improve outcomes. Efforts to reduce variation and improve outcomes for patients will require both central planning and monitoring, as well as region-specific intervention.
越来越多的证据表明，我们的人群中最佳围手术期护理的可及性存在差异。在这项研究中，我们使用国家级数据开始解决我们对新西兰术后结果区域差异理解不足的问题。
使用国家收集的数据，我们检查了 2005 年至 2017 年新西兰公立医院所有住院手术（859171 例急性手术，2276986 例择期/等候名单手术），并确定了 30 天内的死亡病例。我们为 20 个地区卫生局（DHB）计算了每 100 例手术的粗死亡率和调整死亡率，包括总人口和按族裔（毛利/欧洲）分层的死亡率。使用粗死亡率和调整后的泊松回归模型计算毛利和欧洲患者术后死亡风险的比值比。
我们观察到术后死亡率结果存在区域差异。与欧洲患者相比，毛利患者在几个 DHB 中经历了更高的术后死亡率，几乎所有 DHB 中都存在死亡率上升的趋势。年龄、手术、贫困和合并症（尤其是）模式的区域差异在很大程度上导致了术后死亡率的区域差异，尽管在调整了这些因素后，一些地区仍存在差异。尽管调整了多种因素，毛利族裔的不平等结果仍在一些地区持续存在，尤其是在择期治疗环境中。
尽管调整了混杂因素和中介因素，但变异和种族差异仍然存在，这表明多个地区需要额外的资源和支持来改善结果。减少患者变异和提高结果的努力需要中央规划和监测，以及针对特定地区的干预。
