An observational study of the incidence and treatment of postpartum anaemia in Aotearoa, New Zealand

Esther Caljé,[[1]] Joy Marriott,[[2]] Charlotte Oyston,[[2,3]] Lesley Dixon,[[4]] Frank H Bloomfield,[[1]] Katie M Groom [[1,5]]

[[1]]Liggins Institute, University of Auckland, Auckland, New Zealand

[[2]]Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences,

University of Auckland, Auckland, New Zealand

[[3]]Middlemore Hospital, Auckland, New Zealand

[[4]]New Zealand College of Midwives, Christchurch, New Zealand

[[5]]National Women’s Health, Auckland City Hospital, Auckland, New Zealand

BACKGROUND

The incidence of postpartum anaemia (PPA) in Aotearoa, New Zealand is unknown. Intravenous (IV) iron is a recent alternative to red blood cell transfusion (RBC-T) for treatment of moderate-to-severe PPA; however, the extent of its use is unknown. Our aim was to report on the incidence and management of PPA.

METHODS

A retrospective observational study of PPA (haemoglobin (Hb) <100g/L) at tertiary hospitals in three regions across Aotearoa (Counties Manukau, Waikato and Canterbury) between 1 July 2019to 31 December 2019. Case note review was undertaken with Hb <90g/L. Management was compared to local and national guidelines.

RESULTS

Eight thousand, eight-hundred and forty-nine women gave birth during the study period: 4,076 (46%) had postpartum Hb testing and 1,544 (38%) had PPA. Of those tested, and after adjusting for deprivation and region, European women had lower adjusted odds ratios compared to Māori for being identified as having PPA (0.46, 95% confidence interval 0.37–0.57, p<0.01). Of 681 women with Hb <90g/L, 278 (41%) received IV-iron only, 66 (10%) RBC-T only and 155 (23%) both. Management varied by severity of PPA (table). Of those receiving RBC-T, 40/221 (18%) were actively bleeding. Māori (92/138, 67%) and Pacific (127/188, 68%) women with Hb <90g/L had the highest incidence of IV-iron use. No guidelines provided recommendations for haemodynamically stable women without active bleeding.

CONCLUSIONS

The incidence and management of PPA differs by ethnicity but fewer than half of women had Hb-testing, making precise determination of incidence impossible. The majority of women with Hb <90g/L received IV-iron, with or without RBC-T. There is a lack of guidelines for clinically stable women. Further research exploring the reasons for differences in PPA by ethnicity is required, as well as evidence on the comparative effectiveness of IV-iron and RBC-T for moderate-to-severe PPA to guide clinical practice and support more consistent care across Aotearoa.

Neonatal gastric perforation, is it preventable?

Sayanthan Balasubramaniam, Sridharan Jayaratnam, Miranda Bailey-Wilde, Udaya Samarakkody

Waikids Department of Paediatric Surgery and Neonatal Intensive Care Unit, Te Whatu Ora Waikato, Hamilton, New Zealand

AIM

Neonatal gastric perforation (NGP) is a rare surgical emergency needing urgent surgical intervention. This study aimed to find any preventable cause of NGP.

METHODS

We retrospectively reviewed clinical notes, charts, and operative findings of all neonates with gastric perforation for 22 years. The demography, gestational age at birth, age of perforation, potential risk factors during Neonatal Intensive Care Unit (NICU) stay, intraoperative findings, surgical incision site and outcomes were analysed.

RESULTS

Eight babies with NGPs were identified in NICU (three babies—Māori, three—Pākehā). The gestational age ranged from 24–35 (mean 28.4±3.4 weeks), and the birth weight was 700g to 3,030g (mean 1,402g). Seven had respiratory distress needing CPAP (n=6) or intubation (n=1). One baby on room air had <1cm perforation in the posterior gastric wall caused by the nasogastric tube (NGT). The intubated baby had a 1.5cm perforation due to necrotising enterocolitis (NEC) involving the posterior gastric wall. The remaining six babies had the perforation at the greater curvature (GC). The perforations longer than 2cm were associated with C-PAP (p<0.05). Six had left upper quadrant surgical incisions due to pre-operative suspicion, and two had right-sided incisions requiring an extension of the incision. The NGP mortality is 1 out of 8 (12.5%).

CONCLUSION

C-PAP is the leading cause of gastric perforation in low birth weight and premature babies. Careful radiological and clinical assessment for a firm pre-operative diagnosis leads to appropriate surgical incision. NG tube on drainage during CPAP may prevent pneumatic rupture.

GP prescription patterns for atopic eczema in children before and after teledermatology advice

Geoffrey Ying,[[1]] Karen Koch[[2]]

[[1]]Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

[[2]]Department of Dermatology Waikato Hospital, Waikato Hospital, Hamilton, New Zealand

BACKGROUND

Despite comprehensive guidelines, atopic eczema in children remains widely undertreated. Access to dermatologists is limited and the majority of children are treated in primary care. We reviewed whether tailored dermatologist advice, offered via telemedicine (in the form of a written non-contact first specialist appointment (ncFSA) was able to influence general practitioner (GP) prescribing patterns.

OBJECTIVE

To assess whether advice provided to GPs through ncFSA for paediatric atopic eczema influences actual prescribing, and whether this adheres to current best practice.

METHODS

A retrospective review of data was performed comparing dermatologist prescribing advice in the ncFSA to actual GP prescribing in the 6 months following referral. Analysis was performed to assess equity for different socio-economic positions, rurality, and Māori patients.

RESULTS

One hundred and sixty-two patients were included in the study including 83 males and 79 females with an average age of 62 months. Prior to ncFSA, 29 (17.9%) of patients were receiving an appropriate topical corticosteroid for affected eczema areas, which increased to 97 (59.9%) post ncFSA. The number of children receiving an appropriate moisturiser also increased from 47 (29%) to 88 (54.3%). Antimicrobial, combination corticosteroid with antimicrobial, sedating antihistamine and antibiotic use all decreased post ncFSA. Systemic corticosteroid use was similar before and after ncFSA.

The quantity/quality of the medications that patients received did not seem to be affected by ethnicity, with the exception of systemic corticosteroids and antibiotics, which Māori patients were more likely to receive. Rurality was positively associated with amount of topical corticosteroid and moisturiser received, as was a higher level of socio-economic deprivation.

Overall 58.2% of products recommended by dermatology were dispensed, and 50.8% of dispensed products had been recommended in the ncFSA.

CONCLUSION

While there were positive changes seen post-ncFSA, such as more appropriate topical corticosteroids and moisturisers being prescribed, issues such as antimicrobial/combination corticosteroid use continued to persist. The lack of correlation between the medications recommended in the ncFSA and the medications prescribed, suggests a need for better communication, and education in primary care setting. In addition, perhaps other methods of delivering specialist treatment/advice to paediatric eczema patients should be explored.

Post-reduction observation of paediatric intussusception in Waikato, New Zealand

Shirin Gosavi,[[1]] Kristine Jung,[[1]] Brodie Elliott,[[2]] Udaya Samarakkody[[1]]

[[1]]Dept of Paediatric Surgery, Waikato Hospital, Hamilton, New Zealand

[[2]]Dept of Paediatric Surgery, Starship Hospital, Auckland, New Zealand

AIM

To assess the management and outcomes in children with intussusception in the Waikato Region over 15 years.

MATERIAL AND METHODS

This is the Waikato arm of a national multi-centre retrospective study. We collected data from 1 January 2007 to 1 January 2022 on patients under 15 who underwent radiologic or surgical intervention for intussusception. In addition to demographic data, we recorded the duration of hospital stay, need for surgery and, rate of recurrence in children with intussusception, use of antibiotics. The primary outcome was the duration of stay after enema reduction. Patients with incomplete data were excluded from the RECAP platform for data collection, and statistics were done in the Tableau app.

RESULTS

Out of the 92 patients, we excluded two. Forty-seven (52 %) patients were transferred from another hospital. Sixty-six (73 %) were males, and 24 (26%) were females. Māori comprised 23% (n=26). The post-enema reduction length of stay was 25.18 hours on average. Ultrasound detected intussusception in 98% of the patients. Forty-three (48%) needed surgical intervention. Sixty-three percent (n=51) were successful with air enema. Only three (3%) patients had a recurrence, with two having it in the same admission. All of them were treated with another enema reduction. No antibiotics were given to 39 (43%) patients.

CONCLUSION

In most cases, intussusception is successful with air enema reduction, and few patients require surgical options. A management protocol with multi-departmental input has the potential to reduce unnecessary operations and decrease the time in the hospital.

The implementation of healthy homes screening in paediatric wards of Waikato Hospital, New Zealand, has the potential to improve health outcomes and reduce hospital admissions 

 Leah Porima,[[1]] Polly Atatoa Carr,[[2]] Amy Jones,[[3]] Nina Scott[[3]]

[[1]]Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand 

[[2]]Department of Paediatrics, Te Whatu Ora Waikato, Hamilton, New Zealand 

[[3]]Māori Equity Strategy and Research, Te Puna aa Rangahau, Te Whatu Ora Waikato, Hamilton, New Zealand 

OBJECTIVES

There is a well-established relationship between housing conditions, health outcomes, and health equity, for tamariki (children). However, few studies have assessed how the implementation of healthy homes screening affects the rate of referral to housing support services in a health setting. The objectives of this research were to examine the relationship between poor housing conditions and paediatric hospital admissions at Waikato Hospital over a 6-year time frame. Further, healthy homes screening data from the Harti Hauora Tamariki randomised controlled trial (RCT) was compared between the usual care and intervention group in order to evaluate the rate of referrals to the local healthy homes initiative—Whare Ora.

METHODS

A coding algorithm was used to determine how many admissions (aged 0–5 years) to Waikato Hospital acute paediatric medical wards, between February 2014 and February 2020, would have been potentially avoidable due to poor housing quality.

Cross sectional analysis of data obtained in the Harti Hauora Tamariki RCT was compared between tamariki who received the Harti intervention, which included healthy homes screening, and those that received usual care. Clinical notes and the Whare Ora databases were searched to find any documentation of housing information, interventions received, and the rate of referral to Whare Ora for both groups.

RESULTS

More than 50% of paediatric medical admissions at Waikato Hospital were considered potentially avoidable due to poor quality housing. Over 65% of all tamariki Māori admissions were considered potentially avoidable. For the cohort of patients in the Harti RCT, with the use of the healthy homes screening, documentation of housing information (99%) was almost double that of usual care (53%). The housing information gathered could be used to determine eligibility for referral to Whare Ora services. Thirty-three percent of the intervention cohort were referred to Whare Ora, with only 20% of the usual care cohort referred. 

CONCLUSIONS

Poor housing conditions are a predisposing factor in more than half of paediatric medical admissions at Waikato Hospital, and they also contribute to health inequities. Implementation of the Harti Hauora intervention significantly improved housing assessment, documentation, and, more importantly, led to an increased rate of referral to the Whare Ora programme, therefore reducing the risk of further hospitalisation, GP visits and medication need. The potential health equity gains from increased referrals are significant, leading to reduced avoidable paediatric hospital admissions and readmissions and even mortality.

Ngā hua o te kōpū – improving health outcomes for wāhine māori with diabetes in pregnancy

Elizabeth Lewis-Hills (Ngāti Whātua),[[1,2,3]] Donna Cormack (Kāi Tahu, Kati Māmoe),[[3]] John Parsons,[[2]] Jade Tamatea (Ngāti Maniapoto, Te Aitanga-ā-Māhaki)[[1,3]]

[[1]]Te Whatu Ora Waikato, Hamilton, New Zealand

[[2]]Department of Nursing, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand

[[3]]Te Kupenga Hauora Māori, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand

INTRODUCTION

Ngā Hua o te Kōpū recognises colonial impacts on Māori inequities in diabetes in pregnancy (DiP). The prevalence of DiP rise in Māori results in poor intergenerational health outcomes. This study’s objective was to amplify voices of wāhine Māori to produce recommendations to the Waikato DiP service to improve Māori health outcomes.

METHODS

Utilising transformative kaupapa Māori research (KMR) methods five focus groups occurred across the Waikato region in Kirikiriroa (Hamilton), Hauraki, Rāhui Pōkeka (Huntly), Taumarunui and Tokoroa, to share wāhine Māori space, knowledge, and experience of DiP.

RESULTS

Thematic analysis identified three themes 1) impact of diabetes: the importance of time for wāhine to accept their diagnosis and activate self-management of diabetes; 2) relationships: between wāhine and clinicians, and value whānau contributions; and 3) aspirations for DiP: including three sub-themes calling for options in the areas antenatal clinic, modes of communication mode and Māori-led sharing of information and education.

DISCUSSION

The themes and their associated sub-themes illustrated four kaupapa pou (pillars) that illustrate how services can meet the aspirations of wāhine Māori. Whanaungatanga (reciprocal relationships), tino rangatiratanga (self-determination), manaakitanga (centralising Māori with DiP voices), and the Crown’s obligation to uphold te Tiriti obligations.

CONCLUSION

Ngā Hua o te Kōpū highlighted themes explaining wāhine experience of DiP care which extend to four pou outlining wāhine Māori-informed initiatives for DiP service changes. While it is not possible to undo the impacts of colonisation on Māori, this research project reflects and learns from the past to make progress for the future. A future where Māori navigate their own journey for DiP care (tino rangatiratanga) with support of the Crown (te Tiriti obligations), utilising reciprocal relationships (whanaungatanga) within a DiP service that delivers respectful, generous, care for others (manaakitanga).

ACKNOWLEDGEMENTS

Waikato Medical Research Foundation

Wāhine research partners experiential expertise and knowledge

Acute calcium pyrophosphate crystal arthritis is associated with an increased rate of hip and knee joint surgery

David Harris,[[1]] Chris Frampton,[[2]] Sandeep Patel,[[3]] Douglas White,[[1,4]] Uri Arad[[1]]

[[1]]Rheumatology Department, Waikato Hospital, Hamilton, New Zealand

[[2]]University of Otago, Christchurch, New Zealand

[[3]]Orthopaedic Department, Waikato Hospital, Hamilton, New Zealand

[[4]]Waikato Clinical School, University of Auckland, Hamilton, New Zealand

BACKGROUND

Acute calcium pyrophosphate (CPP) crystal arthritis is a distinct manifestation of calcium pyrophosphate crystal deposition (CPPD). No studies have specifically examined whether acute CPP crystal arthritis is associated with progressive structural joint damage. This retrospective cohort study evaluated the relative rate of hip and knee joint arthroplasties as a surrogate of structural joint damage accrual, in a population of patients with acute CPP crystal arthritis.

METHODS

Data were collected from Waikato District Health Board (WDHB) to identify a study population with clinical episodes highly characteristic of acute CPP crystal arthritis. Data on hip and knee joint arthroplasties were collected from the New Zealand Orthopaedic Association’s (NZOA) Joint Registry. The rate of arthroplasties in the study group were compared to the age-ethnicity matched New Zealand population. Additional analysis was performed based on age, obesity (BMI) and ethnicity.

RESULTS

The study population included 99 patients, 63 were male and the median age was 77 years (interquartile range [IQR] 71–82). The obesity rate was 36% with a median BMI of 28.4kg/m[[2]] (IQR 25.8–32.2), comparable to the New Zealand population. The standardised surgical rate ratio in the study group versus the age matched New Zealand population was 2.54 (95% CI: 1.39–4.27).

CONCLUSION

Our study identified a significant increase in the rate of hip and knee joint arthroplasties in patients with episodes of acute CPP crystal arthritis. This suggests CPP crystal arthritis may be a chronic condition, leading to progressive structural joint damage.

Comparison of three delirium screening tools for detecting pacu delirium

Anjera Banerji,[[1]] Jamie Sleigh[[1]]  

[[1]]Waikato Clinical Campus, University of Auckland, Anaesthesiology, Auckland, New Zealand

AIM

Early signs of delirium are commonly observed in the Post Anaesthesia Care Unit (PACU); however, delirium screening tools validated in the PACU setting are lacking. We compared three frequently used tests to identify a sensitive test to screen for PACU delirium.

METHODS

This was a post hoc secondary analysis of data from the Alpha Max study, which involved 200 patients aged over 65 scheduled for elective surgery under general anaesthesia lasting more than 2 hours. Patients were assessed for delirium 30 minutes following arrival in the PACU, if they were adequately arousable. The tests performed for delirium screening were 3D-CAM, CAM-ICU, and NuDESC, each of these multidomain instruments were compared to one another to determine the most appropriate test to detect delirium in the PACU.

RESULTS

Our study’s incidence of PACU delirium was 35% (3D-CAM) and individual cognitive domains were affected differently. CAM-ICU (27%) and NuDESC (52.8%) detected fewer PACU delirium cases than 3D-CAM. CAM-ICU had a sensitivity of 0.27 (with 95% CI 0.17–0.39), while NuDesc had a sensitivity of 0.48 (with 95% CI 0.36–0.61). The specificity of both tests was 1 (with 95% CI 0.97–1.0) and 0.97 (with 95% CI 0.93–0.99), respectively.

CONCLUSION

While highly specific, neither CAM-ICU nor NuDESC are adequately sensitive to identify delirium in the PACU. The instruments of delirium screening used in our study assessed the same cognitive domains, however the complexity of the assessments varied, rendering specific tests less challenging than others.

Abbreviations:3D-CAM = 3-minute Diagnostic Confusion Assessment Method; CAM-ICU = Confusion Assessment Method ICU; NuDesc = Nursing Delirium Screening Scale.

Post-operative outcomes of intracapsular tonsillectomy with coblation: a systematic review and meta-analysis

Huiying Lin,[[1]] Behzad Hajarizadeh,[[2]] Andrew Wood,[[1,3]] Kumanan Selvarajah,[[3]] Omid Ahmadi[[1,3]]

[[1]]Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

[[2]]The Kirby Institute, University of New South Wales, Sydney, NSW, Australia

[[3]]Department of Otolaryngology and Head and Neck Surgery, Waikato Hospital, Hamilton, New Zealand

AIM

In the post-operative course following tonsillectomy, haemorrhage from the tonsillar bed can be a significant and serious complication. With consideration of long-term symptom alleviation, intracapsular tonsillectomy with coblation is considered to minimise short term post-operative complications. This systematic review and meta-analysis seek to analyse available data on short term complications and long-term outcomes from intracapsular tonsillectomy with coblation focusing primarily on post-tonsillectomy bleeding rates.

METHODS

A pre-piloted search strategy was used to search MEDLINE, Embase and the Cochrane library. Studies published in the English language between December 2002 and July 2022 with primary data on post-tonsillectomy haemorrhage with intracapsular tonsillectomy with coblation were identified from the search. Studies were excluded if they were not full text, lacked primary data or did not report rates of post-tonsillectomy haemorrhage. Studies were screened by title, abstract and full text by two independent reviewers. Data were extracted by a pre-piloted form and results summated and analysed.

RESULTS

Data from 9,821 patients across 14 studies were used in quantitative analysis. The overall proportion of total haemorrhage was 1.0% (CI 0.5%–1.6%). Primary and secondary haemorrhage proportions were 0.1% (CI 0.0–0.1%) and 0.8% (0.2%–1.4%) respectively. The proportion requiring further tonsil surgery was 1.4% (CI 0.6–2.2%) though with high heterogeneity.

CONCLUSIONS

Post-tonsillectomy haemorrhage rates in this systematic review and meta-analysis demonstrate that intracapsular tonsillectomy with coblation is safe from the perspective of post-tonsillectomy bleeding. Data regarding long-term tonsil regrowth and need for re-operation was encouraging of the efficacy of the technique, though demonstrated variability which limited the strength of analysis.

Shared decision making for older patients with colorectal cancer: a novel approach

Alison Jackson,[[1]] Brian O'Sullivan,[[2]] Siva Govender,[[3]] Jesse Fischer[[2,4]]

[[1]]Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand

[[2]]Department of General Surgery, Waikato Hospital, Hamilton, New Zealand

[[3]]Department for Older Persons and Rehab Services, Waikato Hospital, New Zealand

[[4]]Department of Surgery, University of Auckland, New Zealand

AIM

Colorectal cancer (CRC) is common in older patients, and medical comorbidity makes decision making around major surgery complex. The traditional approach relies on the surgeon to identify high-risk patients then work-up and/or refer appropriately. We describe early experience of a novel patient-centred shared decision making (SDM) pathway in our tertiary referral centre for older patients with colorectal cancer in which surgical resection is being considered. The pathway goals are to identify high-risk surgical candidates, stratify risk and enable SDM when moderate or high-risk surgery is deemed the gold standard treatment by the colorectal multi-disciplinary meeting (MDM).

METHODS/INTERVENTIONS

From 1 January to 31 December 2020, all patients diagnosed with CRC over 70 years of age were directed to be screened for frailty using the G8 frailty score prior to the colorectal MDM at Waikato Hospital. A prospective database was maintained of all patients with CRC over the age of 70 years discussed at the CRC MDM. Additional retrospective data collection was performed for follow-up data. An anaesthetist and a geriatrician routinely attended the MDM and the first specialist appointment (FSA) in the colorectal surgery clinic to facilitate a SDM approach in a single appointment. Patients being considered for CRC surgery with a G8 frailty score <14 or with multiple comorbidities underwent a holistic assessment by an anaesthetist, geriatrician and colorectal surgeon. Outcomes assessed included frailty scores, mortality, deviation from MDM recommendation, complications and length of stay (LOS).

RESULTS/OUTCOMES

One hundred and seventy-seven patients over 70 years (median 78, range 70–94) were discussed in the MDM during the study period. Median follow-up was 12.3 months. One hundred and six had a G8 score completed, median G8 was 13. Forty-three out of one hundred and seventyt-seven patients were seen in the SDM clinic (31 with anaesthetist and 42 with geriatrician). Surgery was recommended in MDM (prior to FSA) in 39/43 (90.7%) of SDM clinic patients, following clinic review 17/39 (43.6%) did not have surgery. All 17 of these patients were alive at 3 months, but seven died during follow-up (median 6 months). Twenty-two patients had surgery planned to follow the SDM clinic. For those that did undergo surgery all were alive at 3 months, but two died during follow-up, after four and 14 months. Median LOS was 7 days for all SDM patients; two patients returned to theatre in less than 30 days. Seventy out of one hundred and seventy-seven patients were seen by a colorectal surgeon separate to the SDM, 66 for whom surgery was recommended by the MDM. Fifty-seven out of sixty-six patients underwent surgery, of which 55/57 (96.5%) were alive at 3-month follow-up and seven died during follow-up at a median of 4 months. Median LOS was 6 days for non-SDM patients; six patients returned to theatre in less than 30 days.

CONCLUSION/DISCUSSION

Almost half of patients seen in the SDM clinic did not have surgery despite this being the MDM recommendation. Patients from the SDM clinic who did not have surgery had a high early mortality rate, unlikely due to cancer progression. The SDM model described may improve decision making for older patients with CRC by tailoring risk assessment and discussion of treatment options with all key stakeholders in an efficient and timely fashion. Further work is being done to elucidate differences in outcomes for SDM clinic patients as well as obtaining the results of longer follow-up.

Outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: 12 years of experience in a national referral centre in Aotearoa New Zealand

Rennie Qin, Jia Lim, Jasen Ly, Jesse Fischer, Nick Smith, Mosese Karalus, Linus Wu, van Dalen R, Lolohea S

Department of General Surgery, Te Whatu Ora Waikato, Hamilton, New Zealand

INTRODUCTION

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of care for selected cases of peritoneal malignancy.

AIMS

We aimed to evaluate the outcomes following CRS and HIPEC at Waikato District Health Board and Braemar Hospital, which have provided treatment for patients from all regions in New Zealand since 2008.

METHODS

Retrospective review of a prospectively maintained database of all patients undergoing CRS and HIPEC from 1 January 2008 to 1 November 2020 at Waikato District Health Board and Braemar Hospital. We analysed operative outcomes, perioperative morbidity and mortality, and long-term survival.

RESULTS

Two hundred and forty procedures were performed for 221 patients with a median age of 55 years. One hundred and seventy-two patients were European, 29 were Māori, and 14 were Pasifika. There was considerable variation in the number of referrals from different regions of New Zealand. The median PCI was 16. One hundred and ninety-six cases (81.7%) received complete cytoreduction (CC0/1), 33 (13.8%) underwent palliative debulking, and 11 (4.6%) had an abandoned procedure. HIPEC was administered to 100% of CC0/1 cases and 6.8% of CC2/3 cases. Fifty-six cases (23.3%) had at least one major complication (Clavien–Dindo grade 3 or 4). There were two mortalities (0.8%) within 30 days. There were 152 low-grade appendiceal mucinous neoplasm (LAMN), 20 high-grade appendiceal mucinous neoplasm (HAMN), 29 appendiceal cancers, 39 colorectal cancers, eight ovarian cancers, and six peritoneal mesothelioma. Five-year overall survival (OS) for LAMN, HAMN, appendiceal cancer, and colorectal cancer were 71.5%, 49.5%, 20.8%, and 40.4%, respectively.

CONCLUSIONS

We found favourable short- and long-term outcomes following CRS and HIPEC in New Zealand comparable to the international literature.