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The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis
Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. (IMH)ORCID iD: 0000-0003-2888-4111
2018 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, no 1, p. 146-155Article in journal (Refereed) Published
Abstract [en]

Background

The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.

Methods

Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.

Results

We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P<0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P<0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P<0.01; I2=89%).

Conclusions

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 120, no 1, p. 146-155
Keyword [en]
cohort studies; operative/mortality; postoperative care/methods; postoperative care/statistics and numerical data; surgery; surgical procedures
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-145325DOI: 10.1016/j.bja.2017.08.002PubMedID: 29397122OAI: oai:DiVA.org:liu-145325DiVA, id: diva2:1185067
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-03-01Bibliographically approved

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Chew, Michelle
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CiteExportLink to record
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Citation style
  • apa
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