Jamie-Lee Rahiri

• MBChB PhD
• Research Director at Tuhauora Medical Associates

Background: The Royal Australasian College of Surgeons (RACS) Te Rautaki Māori cites the need for more research dedicated to health equity in surgery for Māori. However, the gaps in research for Māori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over...

Background The Royal Australasian College of Surgeons (RACS) recently instituted cultural safety and cultural competency as its 10th competency with formalized cultural safety training yet to be instituted. Wānanga are Indigenous Māori teaching institutions that can be used contemporarily for cultural safety training. Methods In 2022, surgical reg...

aim: Ruptured abdominal aortic aneurysm (rAAA) is associated with a high mortality rate which is especially significant in rural and provincial regions. In Aotearoa New Zealand, Māori experience higher rates of AAA and worse overall medium-term survival following AAA repair. This study aimed to understand the prevalence of incidental AAA on routine...

Background Nearly 5 years after the arrival of coronavirus disease (COVID‐19) in New Zealand (NZ), many lessons have been learned. At North Shore Hospital (NSH) in Auckland, NZ, a general surgical COVID‐19 Crisis Roster (CCR) was established for the first lockdown in 2020. This study summarizes the prospective monitoring of our CCR and offers a fra...

Background: Māori and Pacific peoples carry the highest burden of cardiovascular disease in New Zealand (NZ). This systematic review aimed to determine access to evidence-based cardiovascular disease risk assessment (CVDRA) and management in primary care for Māori and Pacific peoples compared with other ethnicities in NZ, as well as factors contrib...

Background Māori, the Indigenous people of Aotearoa, New Zealand (NZ), experience significant inequities in access to surgery and postoperative outcomes. This scoping review aimed to present a synopsis of the extent and nature of research concerning Māori in surgery in NZ and evaluated the responsiveness of this evidence base to Māori using two Ind...

Objectives To explore the perspectives of Māori and Pacific women who participated in the Fish Oil study to ascertain what barriers and facilitators may exist for successfully recruiting Māori and Pacific women into clinical trials. Design A Kaupapa Māori qualitative study. Setting Auckland, New Zealand. Participants 16 Māori and Pacific women w...

Introduction Enhanced recovery after surgery (ERAS) programs have become increasingly popular in the management of patients undergoing colorectal resection. However, the validity of ERAS in rural hospital settings without intensive care facilities has not been primarily evaluated. This study aimed to assess an ERAS protocol in a rural surgical depa...

Background Prolonged postoperative ileus (PPOI) is associated with higher morbidity and extended inpatient stay. Although evidence suggests that PPOI is more common following right‐sided resections, it is uncertain if return to bowel function is similar following extended right (ERH) versus right hemicolectomy (RH). Methods The recovery of patient...

The establishment of a culturally diverse surgical workforce, largely on the basis of gender, has been highly promoted in Australasia in the last decade. Despite this, discussions of gender diversity in surgery have largely excluded Indigenous women. This study presents the experiences of wāhine Māori and Pasifika doctors in Aotearoa, who formed a...

Indigenous experiences of hospitalisation may contribute to maintenance of Indigenous health inequities. We undertook a qualitative systematic review of Māori experiences of hospital care within New Zealand. We performed electronic database searches and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to assist...

Introduction Māori continue to experience inequitable healthcare and health outcomes compared with other New Zealanders. A narrative review conducted in 2016 described disparities in access to and through the surgical care pathway for Māori from a limited pool of small retrospective cohort studies. This review only targeted studies that specificall...

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues’ experiences and published evidence. Methods: In late 2020, BJS...

Background In March 2020, in response to the Coronavirus Disease 2019 (COVID-19) pandemic, the New Zealand (NZ) Government instituted a four-level alert system, which resulted in the rapid dissolution of non-urgent surgical services to minimise occupational exposure to both patients and staff, with the primary health sector bearing most of the dive...

This article describes the challenge of addressing indigenous health leadership to reduce ethnic disparity in modern healthcare. The indigenous New Zealand population, Māori, are disadvantaged across many health domains including the socioeconomic determinants of health. The Treaty of Waitangi, considered New Zealand’s founding document, outlines M...

Aim To determine whether receipt of publicly funded bariatric surgery varies by ethnicity, after adjustment for comorbidities. Methods A cohort study of New Zealanders aged 30-79 years who had cardiovascular risk assessment in primary care between January 1, 2010 and June 30, 2018 was performed. Data were collated and analyzed using an encrypted u...

IntroductionEmergency laparotomy (EL) is a commonly performed operation with high rates of morbidity and mortality. Despite a growing body of literature on outcomes from EL, there is sparse literature on the patient experience. The aim of this study is to capture the perspective of patients on their EL experience. Qualitative methodology is used as...

Access to publicly funded bariatric surgery in New Zealand is limited, but privileges patients who identify as New Zealand European or Other European. This example of institutional racism in the New Zealand health system further reiterates that Māori face inequitable access to gold standard medical interventions. This article analyses semi-structur...

“I think New Zealand is the best place on the planet, but it’s a racist place.” Taika Waititi (9 April, 2018)

Background In New Zealand (NZ), Indigenous Māori and Pacific peoples experience a higher burden of obesity and obesity-related disease. Counties Manukau Health (CMH) provides the largest public bariatric service in NZ housing a higher proportion (64%) of non-European groups (Asian, Pacific and Māori). This study investigated whether ethnic disparit...

Objective This review aims to identify and summarize the literature pertaining to the implementation of affirmative action programs (AAP) for selection of ethnic minorities and Indigenous peoples into selective specialist medical and surgical training programs. Methods A systematic literature search was conducted to identify relevant studies repor...

Background Health equity is a fundamental right afforded to all regardless of ethnicity. However, in New Zealand (NZ), health inequities are most compelling for Indigenous Māori who experience inadequate access to services, poorer quality of care and poor health outcomes as a result. Bariatric surgery is the most effective intervention for weight l...

Introduction Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Māori...

Background Bariatric surgery has become topical in the media worldwide, influencing wider societal attitudes towards obesity and obesity management. This study aims to explore the media portrayal of bariatric surgery in all print news articles published in New Zealand (NZ) over a decade. Methods An electronic search of two databases (Proquest Aust...

Aim: To assess the effectiveness of the addition of local anesthetic (LA) techniques in reducing pain and morphine consumption in the first 24 hours following laparoscopic ventral hernia repair (LVHR) in adults. Background: Ventral hernias (VH) are a common condition; with risk factors (including obesity), the incidence of VH is projected to increa...

Introduction: Indigenous peoples suffer high rates of obesity and obesity-related disease worldwide. Currently, bariatric surgery is the most effective intervention for severe obesity and obesity-related disease. The role bariatric surgery plays in alleviating the obesity burden amongst Indigenous peoples is unknown. We aimed to collate studies in...

Background: Ethnic disparities in surgical care and outcomes have been previously reported in studies for other surgical procedures. In addition, it has been reported that ethnic differences in postoperative analgesia exist. We aimed to determine ethnic disparities in postoperative outcomes, total opioid analgesia use, and complication rates of al...

Background Bariatric surgery, in recent times, has gained media attention that has influenced individual, healthcare provider and wider societal attitudes towards bariatric surgery. Studies exploring public and media levels of interest in bariatric surgery have been performed overseas but studies within New Zealand (NZ) are scarce. Analysis of Goog...

Background: Significant pain can be experienced after laparoscopic cholecystectomy. This systematic review aims to formulate PROSPECT (PROcedure SPECific Postoperative Pain ManagemenT) recommendations to reduce postoperative pain after laparoscopic cholecystectomy. Methods: Randomised controlled trials published in the English language from Janu...

Aim: Media constructs in Aotearoa, New Zealand naturalise the dominant Western culture. Conversely, mainstream news about Māori is rare and prioritises negative stereotypical constructs that are often centred on Māori as economic threats via resource control and political activism. These narratives influence continued discrimination against Māori...

An understanding of biological fluids at the site of administration is important to predict the fate of drug delivery systems in vivo. Little is known about peritoneal fluid; therefore, we have investigated this biological fluid and compared it to phosphate-buffered saline, a synthetic media commonly used for in vitro evaluation of intraperitoneal...

Background: Health equity for Indigenous peoples in the context of surgery has recently become topical amongst surgeons in Australasia. Health inequities are amongst the most consistent and compelling disparities between Māori and New Zealand Europeans (NZE) in New Zealand (NZ). We aimed to investigate where ethnic disparities in surgical care may...

Background: Publicly funded bariatric surgery in New Zealand (NZ) is steadily on the rise to meet the obesity epidemic. Ethnic disparities in obesity rates exist in NZ with Māori and Pacific people having three to five times higher rates than all other ethnic groups within NZ. Ethnic disparities in rates of bariatric surgery have been reported int...

Background: Colorectal surgery leads to morbidity during recovery including pain and fatigue. Intravenous (IV) lignocaine (IVL) has both analgesic and anti-inflammatory effects that may improve post-operative pain and recovery. The aim of this review is to compare the effectiveness of IVL to other perioperative analgesia regimens for reducing pain...

Background No enhanced recovery after surgery protocol has been published for laparoscopic appendectomy. This was a review of evidence-based interventions that could optimize recovery after appendectomy. Methods Interventions for the review Clinical pathway, fast-track or enhanced recovery protocols; needlescopic approach; single incision laparosco...

Background: Anastomotic leakage (AL) following colorectal surgery can be difficult to diagnose owing to varying clinical presentations. This systematic review aimed to assess biomarkers as potential diagnostic tests for preclinical detection of AL. Methods: A comprehensive literature review was conducted according to PRISMA guidelines. All publi...

Background.: Safe and efficacious modalities of perioperative analgesia are essential for enhanced recovery after surgery. Truncal nerve blocks are one potential adjunct for analgesia of the abdominal wall, and in recent years their popularity has increased. Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) have been shown to...

Background: Intraperitoneal local anesthetic (IPLA) reduces postoperative pain as shown by previous systematic reviews. The purpose of this review was to compare the efficacy of IPLA between different types of procedure and to formulate GRADE recommendations for the use of IPLA. Materials and methods: A systematic search for systematic reviews o...

Purpose: Intraperitoneal drug delivery systems (IPDDS) are used to treat a range of medical conditions including intestinal cancer and post-operative pain. Administration of IPDDS often occurs peri-operatively where the composition and physicochemical properties of peritoneal fluid (PF) can vary. Changes in the properties of PF will influence the r...

Purpose: The rheological properties of biological fluids influence in-vivo performance of drug delivery systems. The purpose of this study was to characterize the rheological properties of human peritoneal fluid (PF) collected following abdominal surgery. Methods: Human PF was obtained from 7 patients and characterized for steady state flow and osc...

Aims: Trampoline use is a popular pastime amongst children in New Zealand, and has many advantages for child development. However, recent reports claim that trampoline-associated injuries are still highly prevalent. In order to help prevent these injuries in the future, this study aims to provide more up-to-date epidemiological information in chil...

Study selection: Independent duplicate searching for randomized controlled trials of IPLA versus no IPLA/placebo in children ≤ 18 years of age, reporting pain, or opioid use outcomes. Data extraction: Independent duplicate data extraction and quality assessment using standardized fields. Results The selection process uncovered three eligible pub...

Introduction: The role of rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks in pediatric surgery has not been well established. Objective: We aimed to determine if RSB and TAP blocks decrease postoperative pain and improve recovery in children. Data sources: Duplicate searching of MEDLINE, EMBASE, Cochrane, Web of Science...