Why are some patients more likely to die after surgery than others, and what causes this inequity in outcomes?

This question is at the centre of Dr Cameron Wells’ research into postoperative mortality in Aotearoa New Zealand.

His presentation, Failure to Rescue after Gastrointestinal Cancer Surgery: a driver of hospital variation, ethnic inequities, and a target for quality improvement in Aotearoa recently won the 2025 Louis Barnett Prize.

Named after the first president of the Royal Australasian College of Surgeons, the Louis Barnett Prize recognises outstanding research that benefits patients and the community.

“It is a real honour to join the list of previous winners”, Dr Wells says.
However, most critically, is the recognition the prize gives to his work in turning research “into action to improve surgical care in Aotearoa New Zealand”.

Recognising and managing complications 
Dr Wells’ research focuses on “failure to rescue”—deaths that occur after potentially treatable postoperative complications. His studies show that differences in “rescue” are the major factor driving variation between hospitals in Aotearoa New Zealand. 

Additionally, Māori patients are more likely to die when complications occur after surgery.

“The difference is not in the rate of complications. It is in how quickly they are recognised and managed. That delay in response is what drives the mortality gap,” he explains.

Even after adjusting for age, gender, health status, socioeconomic factors and hospital size, inequities remain.

These differences are a system-wide problem, impacting all hospitals, whether big or small. They arise from a “complex chain of processes” involved in postoperative care, including monitoring, communication, escalation, and access to senior decision-making. Some of this variation may also reflect underlying structural biases within the health system. Addressing these inequities will require a coordinated approach to strengthening postoperative rescue across all settings.

“We need to examine the process that drive variation and inequities in more detail, and make sure we have equity embedded into every step in solutions.”

Dr Wells also believes that early detection of cancers and improved access to primary care are also vital to reducing inequities.

“We need to catch disease earlier and make sure every patient can access quality screening and treatment.”

From patient to surgeon
Dr Wells’ interest in medicine began during his own experience as a patient. As a teenager, he underwent vascular surgery to repair blood vessels in his leg.

“I was looked after by a vascular surgeon in Hamilton who probably has no idea the impact he had on me,” he says.

With a father who worked as a laboratory scientist, science was already part of his life, but surgery offered something more.

“I liked the applied nature of surgery, the mix of science, solving practical problems and connecting with people. You can see the difference you make in real time.”

Using technology for solutions
Dr Wells also leads a research group at the University of Auckland that focuses on using data and technology to improve patient outcomes. Supported by the Health Research Council of New Zealand, his team is developing ways to use artificial intelligence (AI) and new monitoring systems to detect deterioration earlier and make surgery safer.

“We are working on wearable devices that monitor patients’ vital signs and use AI to identify early warning signs of complications,” he explains.

These innovations aim to bridge the gap between technology and patient care.

“If we can identify problems early, we can intervene before patients become critically unwell. This can result in better outcomes for everyone and fewer inequities.”

Dr Wells also sees a future where recovery extends beyond hospital walls.

“We are moving towards models where patients can be safely monitored at home,” he says. “It is about making care smarter, more connected and more equitable.”

Mentorship and collaboration 
Dr Wells is also committed to collaborative research and training. He plays a key role in STRATA, Aotearoa New Zealand’s Trainee-led collaborative research network in General Surgery. “Research is a team sport. No one can do it alone,” he says.

He credits senior mentors for guiding his journey. “I have been fortunate to have people who supported my research ideas early on. That kind of mentorship is what builds the next generation of surgical leaders.”

A vision for equity
As he completes his PhD, Dr Wells remains focused on translating research into meaningful change, using technological innovations, better clinical care, and system-level interventions.

“The long-term vision is simple,” he says. “A health system where every New Zealander has the same chance of excellent surgical outcomes, with no preventable deaths after surgery and no inequities in who survives.

“We have the data, the technology, and the will to do better. Now we need to make sure every patient benefits.”