Abstract
Background: Indigenous populations worldwide experience unjust inequities in surgical outcomes. In Aotearoa New Zealand, Indigenous Māori experience poorer health outcomes, including higher rates of postoperative mortality. The aim of this study was to quantify ethnic disparities in 'failure to rescue' (FTR), complications, and mortality following gastrointestinal cancer surgery and to analyse trends over time.
Methods: A retrospective national population-based cohort study of patients undergoing resection for gastrointestinal and hepatopancreatobiliary cancers from 2005 to 2020 was conducted. Self-reported ethnicity data were collected at the time of surgery. The primary outcome was FTR, defined as mortality following a complication within 90 days of surgery.
Results: In total, 31 185 patients were included; 2479 (7.9%) were Māori, 46.5% were female, and the median age was 71 (interquartile range 62-78) years. Māori patients were younger and had higher levels of socio-economic deprivation and co-morbidity. Māori had higher age-standardized rates of mortality (5.9% versus 3.2%), complications (52.9% versus 42.4%), and FTR (10.8% versus 7.2%), compared with European/Other. Multivariable regression demonstrated higher odds of mortality (adjusted OR (aOR) 1.45 (95% c.i. 1.15-1.82)), complications (aOR 1.30 (95% c.i. 1.17-1.45)), and FTR (aOR 1.29 (95% c.i. 1.01-1.62)) for Māori. Analysis over time showed a significant improvement in risk-adjusted rates of mortality (6.2% in 2005-2008 versus 3.4% in 2017-2020) and FTR (7.3% in 2005-2008 versus 4.0% in 2017-2020) for European/Other, but no change for Māori (rates of mortality were 6.6% in 2005-2008 versus 5.4% in 2017-2020 and rates of FTR were 7.8% in 2005-2008 versus 6.3% in 2017-2020).
Conclusion: Widening inequities in FTR have worsened disparities in postoperative mortality for Māori patients. 'Complication rescue' is a target to reduce inequities and improve perioperative care for Māori patients.