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

  • Abbott, TEF
  • Ahmad, T
  • Phull, MK
  • Fowler, AJ
  • Hewson, R
  • Biccard, BM
  • Chew, MS
  • Gillies, M
  • Pearse, RM
  • International Surgical Outcomes Study (I...
  • Abeloos, Jacques
  • Bouchez, Stefaan
  • Coppens, Marc
  • De Baerdemaeker, Luc
  • De Bruyne, Ann
  • De Hert, Stefan
  • Fonck, Kristine
  • Heyse, Bjorn
  • And 12 more
Publication Date
Jan 01, 2018
Ghent University Institutional Archive
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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; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); P<0.01; I-2 = 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.

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