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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
PMCID: PMC13168996
PMID: 29397122
url
https://doi.org/10.1016/j.bja.2017.08.002View
Published (Version of record) Open Access

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

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