Latest news with #AnnalsofSurgery
Scoop
7 hours ago
- Health
- Scoop
Māori Almost Twice As Likely To Die After Bowel Cancer Surgery
Confronting research data reveals Māori almost twice as likely to die after bowel cancer surgery Māori are almost twice as likely as Pākehā to die from complications following bowel cancer surgery, new research shows. The study, just published in the British Journal of Surgery, found that Māori patients having bowel or gut cancer surgery were slightly more likely to experience complications, such as infections, bleeding, or organ failure. However, the more concerning finding was that Māori were significantly less likely than Pākehā patients to survive those complications. 'That tells us something is going wrong with how our hospital systems respond to Māori patients with problems after surgery,' says lead author Dr Cameron Wells, a doctoral candidate in surgery at Waipapa Taumata Rau, University of Auckland. 'It's not just whether complications happen, but how quickly and effectively they're picked up and treated. Our study shows that for Māori patients, those crucial steps often come too late,' says Wells. The research team included Māori and Pākehā doctors from several hospitals and the universities of Otago and Auckland. They analysed hospital records and data from the New Zealand Cancer Registry for more than 31,000 patients between 2005 and 2020. During this period, hospital teams improved at identifying and treating complications in Pākehā patients, with deaths approximately halving. However, survival rates for Māori showed negligible improvement, widening the mortality gap over the 16 years. 'This is very concerning and confronting data,' says Wells. The study points to structural racism in the healthcare system, unconscious bias, and poor communication as key contributors to the disparity. It highlights that Māori patients with early symptoms of complications may be taken less seriously, causing harmful delays in diagnosis and treatment. Dr Jonathan Koea (Ngāti Mutunga, Ngāti Tama), a professor of surgery in the Faculty of Medical and Health Sciences at Waipapa Taumata Rau, University of Auckland, says this study builds on earlier research. A 2023 paper, also led by Wells, found Māori are proportionally more likely to be treated at hospitals with higher rates of post-surgical deaths. These hospitals often have fewer resources to recognise and respond to complications after surgery. (See Annals of Surgery ' Failure to rescue following colorectal cancer resection'.) Koea also referenced earlier research he was involved with, led by University of Otago Māori epidemiologist Professor Jason Gurney, which found Māori were more likely to die after elective surgery than Pākehā. Contributing factors included communication issues and assumptions about health literacy. (See NZMJ 17 September 2021.) 'This latest study is complex, because it's about something that doesn't happen, a patient's life is not saved when they experience a complication, which makes it hard to measure,' Koea says. 'The research sits within the broader context of the Māori patient journey with cancer. From the outset, Māori are less likely to be screened, less likely to have a GP, more likely to require emergency surgery, and less likely to be referred to an oncologist. 'It's a pattern of multiple slippage points, which is why Māori are more likely to die six or seven years earlier than Pākehā,' Koea says. 'Māori are more likely to experience complications and less likely to be rescued. It aligns with what we already know. 'It shows that treating everyone equally results in unequal outcomes – you have to treat Māori differently to achieve the same outcomes.' Recommendations for improvements The paper recommends identifying and removing barriers to equitable care by embedding cultural safety and anti-racism training for all clinical staff to improve post-surgical outcomes. Strengthening Māori-led models of care and incorporating whānau perspectives into surgical pathways may also improve trust, responsiveness, and outcomes. Wells says the next step is to move from research describing inequities to actually doing something about them. 'We already know where many of the problems lie – the focus now must be on partnering with Māori communities to co-design solutions. That means listening, acting, and making sure the health system delivers care that is culturally safe, equitable, and accountable,' Wells says. There are a range of initiatives under way across New Zealand, he adds. 'One initiative I think has potential is called Kōrero Mai, which enables patients and their families to speak up and request a review by more senior staff in hospital when they are worried about something going wrong. 'We know that for Māori patients, there are significant cultural barriers – this is a broader issue, not limited to surgery.' While hospitals are taking steps to improve monitoring and treatment after surgery, this research suggests current efforts are benefiting some patients but not others. 'We need to be very careful about what we do next, because the gap is getting wider.'
Scoop
a day ago
- Health
- Scoop
Māori Almost Twice As Likely To Die After Bowel Cancer Surgery
Press Release – University of Auckland Confronting research data reveals Māori almost twice as likely to die after bowel cancer surgery Māori are almost twice as likely as Pākehā to die from complications following bowel cancer surgery, new research shows. The study, just published in the British Journal of Surgery, found that Māori patients having bowel or gut cancer surgery were slightly more likely to experience complications, such as infections, bleeding, or organ failure. However, the more concerning finding was that Māori were significantly less likely than Pākehā patients to survive those complications. 'That tells us something is going wrong with how our hospital systems respond to Māori patients with problems after surgery,' says lead author Dr Cameron Wells, a doctoral candidate in surgery at Waipapa Taumata Rau, University of Auckland. 'It's not just whether complications happen, but how quickly and effectively they're picked up and treated. Our study shows that for Māori patients, those crucial steps often come too late,' says Wells. The research team included Māori and Pākehā doctors from several hospitals and the universities of Otago and Auckland. They analysed hospital records and data from the New Zealand Cancer Registry for more than 31,000 patients between 2005 and 2020. During this period, hospital teams improved at identifying and treating complications in Pākehā patients, with deaths approximately halving. However, survival rates for Māori showed negligible improvement, widening the mortality gap over the 16 years. 'This is very concerning and confronting data,' says Wells. The study points to structural racism in the healthcare system, unconscious bias, and poor communication as key contributors to the disparity. It highlights that Māori patients with early symptoms of complications may be taken less seriously, causing harmful delays in diagnosis and treatment. Dr Jonathan Koea (Ngāti Mutunga, Ngāti Tama), a professor of surgery in the Faculty of Medical and Health Sciences at Waipapa Taumata Rau, University of Auckland, says this study builds on earlier research. A 2023 paper, also led by Wells, found Māori are proportionally more likely to be treated at hospitals with higher rates of post-surgical deaths. These hospitals often have fewer resources to recognise and respond to complications after surgery. (See Annals of Surgery ' Failure to rescue following colorectal cancer resection'.) Koea also referenced earlier research he was involved with, led by University of Otago Māori epidemiologist Professor Jason Gurney, which found Māori were more likely to die after elective surgery than Pākehā. Contributing factors included communication issues and assumptions about health literacy. (See NZMJ 17 September 2021.) 'This latest study is complex, because it's about something that doesn't happen, a patient's life is not saved when they experience a complication, which makes it hard to measure,' Koea says. 'The research sits within the broader context of the Māori patient journey with cancer. From the outset, Māori are less likely to be screened, less likely to have a GP, more likely to require emergency surgery, and less likely to be referred to an oncologist. 'It's a pattern of multiple slippage points, which is why Māori are more likely to die six or seven years earlier than Pākehā,' Koea says. 'Māori are more likely to experience complications and less likely to be rescued. It aligns with what we already know. 'It shows that treating everyone equally results in unequal outcomes – you have to treat Māori differently to achieve the same outcomes.' Recommendations for improvements The paper recommends identifying and removing barriers to equitable care by embedding cultural safety and anti-racism training for all clinical staff to improve post-surgical outcomes. Strengthening Māori-led models of care and incorporating whānau perspectives into surgical pathways may also improve trust, responsiveness, and outcomes. Wells says the next step is to move from research describing inequities to actually doing something about them. 'We already know where many of the problems lie – the focus now must be on partnering with Māori communities to co-design solutions. That means listening, acting, and making sure the health system delivers care that is culturally safe, equitable, and accountable,' Wells says. There are a range of initiatives under way across New Zealand, he adds. 'One initiative I think has potential is called Kōrero Mai, which enables patients and their families to speak up and request a review by more senior staff in hospital when they are worried about something going wrong. 'We know that for Māori patients, there are significant cultural barriers – this is a broader issue, not limited to surgery.' While hospitals are taking steps to improve monitoring and treatment after surgery, this research suggests current efforts are benefiting some patients but not others. 'We need to be very careful about what we do next, because the gap is getting wider.'
Scoop
a day ago
- Health
- Scoop
Māori Almost Twice As Likely To Die After Bowel Cancer Surgery
Press Release – University of Auckland The research team included Mori and Pkeh doctors from several hospitals and the universities of Otago and Auckland. Confronting research data reveals Māori almost twice as likely to die after bowel cancer surgery Māori are almost twice as likely as Pākehā to die from complications following bowel cancer surgery, new research shows. The study, just published in the British Journal of Surgery, found that Māori patients having bowel or gut cancer surgery were slightly more likely to experience complications, such as infections, bleeding, or organ failure. However, the more concerning finding was that Māori were significantly less likely than Pākehā patients to survive those complications. 'That tells us something is going wrong with how our hospital systems respond to Māori patients with problems after surgery,' says lead author , a doctoral candidate in surgery at Waipapa Taumata Rau, University of Auckland. 'It's not just whether complications happen, but how quickly and effectively they're picked up and treated. Our study shows that for Māori patients, those crucial steps often come too late,' says Wells. The research team included Māori and Pākehā doctors from several hospitals and the universities of Otago and Auckland. They analysed hospital records and data from the New Zealand Cancer Registry for more than 31,000 patients between 2005 and 2020. During this period, hospital teams improved at identifying and treating complications in Pākehā patients, with deaths approximately halving. However, survival rates for Māori showed negligible improvement, widening the mortality gap over the 16 years. 'This is very concerning and confronting data,' says Wells. The study points to structural racism in the healthcare system, unconscious bias, and poor communication as key contributors to the disparity. It highlights that Māori patients with early symptoms of complications may be taken less seriously, causing harmful delays in diagnosis and treatment. Dr Jonathan Koea (Ngāti Mutunga, Ngāti Tama), a professor of surgery in the Faculty of Medical and Health Sciences at Waipapa Taumata Rau, University of Auckland, says this study builds on earlier research. A 2023 paper, also led by Wells, found Māori are proportionally more likely to be treated at hospitals with higher rates of post-surgical deaths. These hospitals often have fewer resources to recognise and respond to complications after surgery. (See Annals of Surgery ' Failure to rescue following colorectal cancer resection'.) Koea also referenced earlier research he was involved with, led by University of Otago Māori epidemiologist Professor Jason Gurney, which found Māori were more likely to die after elective surgery than Pākehā. Contributing factors included communication issues and assumptions about health literacy. (See NZMJ 17 September 2021.) 'This latest study is complex, because it's about something that doesn't happen, a patient's life is not saved when they experience a complication, which makes it hard to measure,' Koea says. 'The research sits within the broader context of the Māori patient journey with cancer. From the outset, Māori are less likely to be screened, less likely to have a GP, more likely to require emergency surgery, and less likely to be referred to an oncologist. 'It's a pattern of multiple slippage points, which is why Māori are more likely to die six or seven years earlier than Pākehā,' Koea says. 'Māori are more likely to experience complications and less likely to be rescued. It aligns with what we already know. 'It shows that treating everyone equally results in unequal outcomes – you have to treat Māori differently to achieve the same outcomes.' Recommendations for improvements The paper recommends identifying and removing barriers to equitable care by embedding cultural safety and anti-racism training for all clinical staff to improve post-surgical outcomes. Strengthening Māori-led models of care and incorporating whānau perspectives into surgical pathways may also improve trust, responsiveness, and outcomes. Wells says the next step is to move from research describing inequities to actually doing something about them. 'We already know where many of the problems lie – the focus now must be on partnering with Māori communities to co-design solutions. That means listening, acting, and making sure the health system delivers care that is culturally safe, equitable, and accountable,' Wells says. There are a range of initiatives under way across New Zealand, he adds. 'One initiative I think has potential is called Kōrero Mai, which enables patients and their families to speak up and request a review by more senior staff in hospital when they are worried about something going wrong. 'We know that for Māori patients, there are significant cultural barriers – this is a broader issue, not limited to surgery.' While hospitals are taking steps to improve monitoring and treatment after surgery, this research suggests current efforts are benefiting some patients but not others. 'We need to be very careful about what we do next, because the gap is getting wider.'
Time of India
24-07-2025
- Health
- Time of India
Why Evidence based Robotic Surgery Is Becoming the New Standard of Care
New Delhi: In an era where precision is paramount and patient recovery is prioritised more than ever, robotic-assisted surgery (RAS) is no longer a futuristic concept—it is rapidly becoming the gold standard in operating rooms across the globe, and increasingly, in India. Once reserved for complex prostatectomies, robotic surgery today spans a wide range of specialties—from gynecology and gastrointestinal surgery to thoracic and oncologic procedures—delivering consistent benefits for both patients and surgeons. Dr. Myriam Curet, Global Chief Medical Officer, Intuitive Surgical , emphasises that the original value of RAS was in converting open surgeries into minimally invasive ones—a breakthrough that radically reduced hospital stays, post-operative complications, and improved patient outcomes. 'We started in urology where minimal access options were limited,' says Dr. Curet. 'But as evidence grew, we saw the benefits expand to patients previously considered inoperable via laparoscopy, those with high BMI or advanced disease. Now, robotics isn't just an alternative to open surgery, it's proving superior even to laparoscopy in many cases.' The Evidence Speaks A landmark study published in Annals of Surgery, dubbed the COMPARE Study, analysed over a million patients across seven cancer procedures and multiple countries. It found that RAS significantly reduced hospital stay, readmission, complication rates, and blood transfusions—despite a marginally longer operating time. Crucially, conversion rates (where a minimally invasive surgery has to be converted to open mid-procedure) were reduced by more than half with robotic approaches, a game-changer for patient trust and recovery. 'Conversion is traumatic for patients who come in expecting a short stay and walk out with a large incision and longer recovery,' says Dr. Curet. 'Robotics dramatically lowers this risk.' For Dr. Venkat P, a senior consultant robotic surgeon, Apollo Cancer Centre, Chennai, the impact has been nothing short of transformative. 'From reduced ICU stays and wound infections to faster discharge, RAS has become a blessing, especially for elderly or high-risk patients,' he explains. 'In the past, a major surgery meant 10-12 days in the hospital. Now? Two to three days.' He estimates a 40 per cent increase in surgical volumes at his center since adopting RAS. Many patients now actively request robotic surgery even switching hospitals or doctors to access it. 'Our best advocates are patients themselves,' he notes. Dr. Priya Kapoor, a consultant robotic surgical oncologist at Apollo Cancer Centres, highlights the remarkable reduction in hospital-acquired infections (HAIs). 'Our wound infection rate is Beyond infection control, oncologic precision has seen a leap. 'The robotic camera gives us a 10x magnified view, and the instruments offer unmatched dexterity. We can dissect and remove lymph nodes from locations human hands can't reach,' Dr. Kapoor adds. Procedures like robotic Whipple (a procedure to treat tumors and other conditions in the pancreas, small intestine and bile ducts) once deemed too complex are now regularly performed by experienced teams in India. 'Five years ago, robotic colorectal surgeries were rare. Today, they're standard of care,' says Dr. Kapoor. 'Soon, Whipple's will be, too.' Surgeons themselves are seeing improved quality of life. Dr. Curet, a practicing general and bariatric surgeon, recounts how ergonomics was one of the reasons she embraced RAS. 'Laparoscopic bariatric surgery took a toll on long hours, awkward postures, and physical strain. The robot changed that. I could operate comfortably, and my trainees learned faster, cutting learning curves from 100 to 40 cases.' For Dr Vishal Soni, Robotic Gastrointestinal, Hernia - AWR, and Obesity Surgeon, Zydus Hospitals, Ahmedabad, the biggest advantage of RAS lies in its predictability. 'With sub-millimeter precision, what I imagine as a surgeon is what I execute. Outcomes become more predictable, and that brings confidence to both me and my patient,' he says. Dr. Venkat echoes this: 'You're seated, relaxed, focused. Less physical exertion, better mental clarity. It's a win-win.' The Cost Conundrum: Short-Term vs Long-Term While RAS has been criticized for its higher upfront cost, surgeons argue that total cost of care must be considered. With shorter hospital stays, fewer infections, reduced ICU needs, and faster return to normal life, robotic surgery often ends up being more economical in the long run—especially when factoring in caregiver time, income loss, and quality of life. Dr. Venkat summarises it aptly: 'It's not just the hospital bill. Robotic surgery saves time, stress, and resources, for both the patient and their family.' As surgical oncology , GI, gynecology, and thoracic surgery continue to embrace RAS, it's becoming clear that robotic platforms are not just the future, they are the present. With India producing world-class evidence, expanding surgeon training, and deepening patient awareness, the shift is no longer just technological, it's transformational. In the next decade, as Dr. Venkat predicts, 'We won't be talking about robotic surgery. It will just be surgery.'
Yahoo
12-02-2025
- Health
- Yahoo
Almost half of rural Americans drive long distances for surgery
As closures of rural hospitals across the United States continue, more Americans are facing hour-plus drives to reach surgical centers, two new reports find. By 2020, data show, 99 million Americans already had trouble finding "timely, high-quality and affordable surgical care," according to a news release from the University of Michigan. The situation is most dire for people living in rural areas. "One of the big factors creating this situation is hospitals closing in rural areas, with more than 150 lost in the last 14 years, but we can also see indications of other factors related to the health policy environment," said Dr. Cody Mullens, lead author of both studies. It's not just distance that's an issue. Out-of-pocket costs for surgeries are also soaring, even for insured patients. "The number [of patients] who lacked access due to not having insurance shrunk a lot, likely due to the Affordable Care Act, but the number who are underinsured, likely due to the growth in high-deductible health insurance plans and other factors, grew," noted Mullens, a resident physician in surgery at Michigan Medicine. The two studies were published in the February issue of Annals of Surgery and Wednesday's Journal of the American Medical Association. In the Annals study, Mullens' team looked at data on surgical care across the United States for 2011 through 2020. The researchers combed through data supplied by Medicare, Medicaid, the American Hospital Association and elsewhere. Besides finding that by 2020 almost 100 million Americans lacked local access to affordable surgeries, the study also found rural Americans to be especially hard-hit. The researchers defined good access to surgery as "living within an hour's drive of a hospital that offers surgical care and earned at least three stars from the Medicare quality rating system, and being able to afford the out-of-pocket costs of that operation after any insurance coverage." Using this metric, nearly 7% of rural patients were deemed to have "insufficient access to [surgical] care," Mullens' team found, compared to 2% of those living in cities. The second study, published in JAMA, focused on rural Americans who underwent one of 16 types of surgery between 2010 and 2020. These included both low- and high-risk operations. By 2020, 44% of these rural Americans had to drive and hour or more to get to their surgeries, a rise from the 37% noted for 2010. On average, rural patients drove 55 minutes to get to a surgical center, the study found. The combined logistics of long drives and higher costs can have real-world implications for patients' health, Mullens noted. "When we can look at these factors in concert, we can have a better understanding of the net effect of our complex policy environment on patients, who may delay getting surgery and see their condition worsen and become more complex," he said. As the researchers explained, some trends that limit patient access are tied to policies meant to help patients. For example, in an effort to boost quality and safety, there's been a gradual "centralization" of surgeries at fewer and fewer high-quality hospitals in the United States, the team noted. However, routine, low-risk surgeries -- operations such as gall bladder or appendix removal, hernia repair or joint replacements -- can just as safely be done at rural centers, Mullens believes. "It's not acceptable for that large a proportion of patients to drive that far for low-risk surgery that can be performed safely and with high quality at smaller hospitals," he said. In many such cases, doctors may want to consider the inconvenience of driving time when considering appointments leading up to the actual surgery, substituting telehealth sessions instead. As for out-of-pocket surgical costs, there's more to consider when choosing health insurance than just the monthly premium, Mullens and team said. "When someone knows that surgery may be in their future, choosing a Medicare, ACA Marketplace or employer-sponsored plan that does not have a high deductible, starting and adding funds to a tax-free health savings account or flexible spending account, and checking on which hospitals are considered in-network for surgery, can be very important," the team said in a university news release. More information There's help on figuring out your out-of-pocket cost for health care at Copyright © 2025 HealthDay. All rights reserved.
