The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

T.E.F. Abbott; T. Ahmad; Mandeep-Kaur Phull; A J Fowler; R. Hewson; B.M. Biccard; M S Chew; R. M. Pearse; International Surgical Outcomes Study (ISOS) group; Olusola Idowu

doi:10.1016/j.bja.2017.08.002

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The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

Journal article

Open access

Peer reviewed

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

T.E.F. Abbott, T. Ahmad, Mandeep-Kaur Phull, A J Fowler, R. Hewson, B.M. Biccard, M S Chew, R. M. Pearse, International Surgical Outcomes Study (ISOS) group and Olusola Idowu

British journal of anaesthesia : BJA, Vol.120(1), pp.146-155

01/2018

DOI: 10.1016/j.bja.2017.08.002

PMID: 29397122

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Abstract

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. 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. 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%). 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.

Surgery

cohort studies

operative/mortality

postoperative care/methods

postoperative care/statistics and numerical data

surgical procedures

Details

Title: Subtitle: The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis
Creators: T.E.F. Abbott - Queen Mary University of London
T. Ahmad - William Harvey Research Institute
Mandeep-Kaur Phull - The Royal Free Hospital
A J Fowler
R. Hewson - Royal London Hospital
B.M. Biccard - University of Cape Town
M S Chew - Linköping University
R. M. Pearse - William Harvey Research Institute
International Surgical Outcomes Study (ISOS) group
Olusola Idowu (Contributor)
Resource Type: Journal article
Publication Details: British journal of anaesthesia : BJA, Vol.120(1), pp.146-155
Publisher: Elsevier Ltd
DOI: 10.1016/j.bja.2017.08.002
PMID: 29397122
ISSN: 0007-0912
eISSN: 1471-6771
Number of pages: 10
Language: English
Date published: 01/2018
Academic Unit: Anesthesia
Record Identifier: 9984787257002771

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