TY - JOUR
T1 - The surgical safety checklist and patient outcomes after surgery
T2 - a prospective observational cohort study, systematic review and meta-analysis
AU - International Surgical Outcomes Study (ISOS) group
AU - Abbott, T E F
AU - Ahmad, T
AU - Phull, M K
AU - Fowler, A J
AU - Hewson, R
AU - Biccard, B M
AU - Chew, M S
AU - Gillies, M
AU - Pearse, R M
AU - Beattie, Scott
AU - Clavien, Pierre-Alain
AU - Demartines, Nicolas
AU - Fleisher, Lee A.
AU - Grocott, Mike
AU - Haddow, James
AU - Hoeft, Andreas
AU - Holt, Peter
AU - Moreno, Rui
AU - Pritchard, Naomi
AU - Rhodes, Andrew
AU - Wijeysundera, Duminda
AU - Wilson, Matt
AU - Ahmed, Tahania
AU - Everingham, Kirsty
AU - Januszewska, Marta
AU - Halliwell, Richard
AU - Shulman, Mark
AU - Myles, Paul
AU - Schmid, Werner
AU - Hiesmayr, Michael
AU - Wouters, Patrick
AU - de Hert, Stefan
AU - Lobo, Suzana
AU - Fang, Xiangming
AU - Rasmussen, Lars
AU - Futier, Emmanuel
AU - Biais, Matthieu
AU - Venara, Aurélien
AU - Slim, Karem
AU - Sander, Michael
AU - Koulenti, Despoina
AU - Zhang, Xiaolin
AU - Chen, Sijia
AU - Hollmann, Markus
AU - Hulst, Abraham
AU - Slankamenac, Ksenija
AU - Preckel, Benedikt
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045575974&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29397122
U2 - https://doi.org/10.1016/j.bja.2017.08.002
DO - https://doi.org/10.1016/j.bja.2017.08.002
M3 - Article
C2 - 29397122
SN - 0007-0912
VL - 120
SP - 146
EP - 155
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 1
ER -