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

Published on Jan 1, 2018in BJA: British Journal of Anaesthesia6.199
· DOI :10.1016/j.bja.2017.08.002
T. E. F. Abbott2
Estimated H-index: 2
(QMUL: Queen Mary University of London),
T. Ahmad1
Estimated H-index: 1
(QMUL: Queen Mary University of London)
+ 2652 AuthorsTroy S. Wildes10
Estimated H-index: 10
Sources
Abstract
Abstract 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 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 2 =87%] and reduced complication rates [OR 0.73 (0.61–0.88); P 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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References41
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It has been 10 years since the implementation of the World Health Organization (WHO) Surgical Safety Checklist [1]. Adverse events in the operating theatre are a global issue and half of them are often avoidable..
13 CitationsSource
#1G.L. Ackland (QMUL: Queen Mary University of London)H-Index: 1
#2Tom E.F. Abbott (QMUL: Queen Mary University of London)H-Index: 17
Last. Laura Montague (Royal Surrey County Hospital)H-Index: 3
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Abstract Background Systemic arterial pulse pressure (systolic minus diastolic pressure) ≤53 mm Hg in patients with cardiac failure is correlated with reduced stroke volume and is independently associated with accelerated morbidity and mortality. Given that deconditioned surgical and heart failure patients share similar cardiopulmonary physiology, we examined whether lower pulse pressure is associated with excess morbidity after major surgery. Methods This was a prospective observational cohort ...
7 CitationsSource
#1Tom E.F. Abbott (QMUL: Queen Mary University of London)H-Index: 17
#2Alexander J. FowlerH-Index: 16
Last. Rupert M. Pearse (QMUL: Queen Mary University of London)H-Index: 47
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Abstract Background Despite evidence of high activity, the number of surgical procedures performed in UK hospitals, their cost and subsequent mortality remain unclear. Methods Time-trend ecological study using hospital episode data from England, Scotland, Wales and Northern Ireland. The primary outcome was the number of in-hospital procedures, grouped using three increasingly specific categories of surgery. Secondary outcomes were all-cause mortality, length of hospital stay and healthcare costs...
35 CitationsSource
#1Tom E.F. Abbott (QMUL: Queen Mary University of London)H-Index: 17
#2Gary MintoH-Index: 16
Last. Gareth L. Ackland (QMUL: Queen Mary University of London)H-Index: 25
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Abstract Background Elevated preoperative heart rate (HR) is associated with perioperative myocardial injury and death. In apparently healthy individuals, high resting HR is associated with development of cardiac failure. Given that patients with overt cardiac failure have poor perioperative outcomes, we hypothesized that subclinical cardiac failure, identified by cardiopulmonary exercise testing, was associated with elevated preoperative HR > 87 beats min −1 (HR > 87). Methods This was a second...
16 CitationsSource
#1Brennan C Kahan (QMUL: Queen Mary University of London)H-Index: 27
#2Desponia Koulenti (UQ: University of Queensland)H-Index: 1
Last. Rupert M. Pearse (QMUL: Queen Mary University of London)H-Index: 47
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Purpose As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality.
39 CitationsSource
#1Tom E.F. Abbott (QMUL: Queen Mary University of London)H-Index: 17
#2Hew D.T. Torrance (QMUL: Queen Mary University of London)H-Index: 13
Last. Julian Emmanuel (QMUL: Queen Mary University of London)H-Index: 3
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Abstract Introduction The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. Methods This was a prospective cohort study of adult medical admissions to a single-centre over 20 days. Blood gas results a...
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#1H C HemmingsH-Index: 1
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Funded by Nestle Health Sciences through an unrestricted research grant, by a National Institute for Health Research Professorship held by R.P., and sponsored by Queen Mary University of London.
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#2Gareth L. Ackland (QMUL: Queen Mary University of London)H-Index: 25
Last. Rupert M. Pearse (QMUL: Queen Mary University of London)H-Index: 47
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Abstract Background Increased baseline heart rate is associated with cardiovascular risk and all-cause mortality in the general population. We hypothesized that elevated preoperative heart rate increases the risk of myocardial injury after non-cardiac surgery (MINS). Methods We performed a secondary analysis of a prospective international cohort study of patients aged ≥45 yr undergoing non-cardiac surgery. Preoperative heart rate was defined as the last measurement before induction of anaesthesi...
32 CitationsSource
#1Matthias BockH-Index: 1
#2Antonio FanollaH-Index: 1
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Importance The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear. Objective To assess the association between the implementation of SSCs and all-cause 90- and 30-day mortality rates. Design, Setting, and Participants Evaluation of the outcomes of surgical procedures performed during the ...
11 CitationsSource
#1Hector J. LacassieH-Index: 7
Last. Ghislaine C. EchevarriaH-Index: 10
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Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retro...
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Importance Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. Objectiv...
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#1Jiale Hu (SJTU: Shanghai Jiao Tong University)
#2Yan Yang (SJTU: Shanghai Jiao Tong University)H-Index: 1
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Abstract Purpose Whether intraoperative handover of anesthesia care increases the risk of adverse outcomes in patients undergoing surgery remains unclear. This systematic review aimed to synthesize the evidence on the association of intraoperative anesthesia handover with delivery of patient care and patient outcomes. Design This is a systematic review and meta-analysis. Methods A comprehensive search was conducted to identify the eligible studies examining the association between intraoperative...
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OBJECTIVES: To investigate staff attitudes to the use of a surgical safety checklist in a small animal operating room and to gain insight into barriers to use. MATERIALS AND METHODS: A questionnaire was designed and used to assess attitudes of 36 operating room personnel to the checklist. The checklist was retrospectively audited on 984 patients over an 8-month period to investigate compliance. RESULTS: Responses were obtained from 100% of theatre personnel. Attitudes to the checklist were posit...
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Objectives This study investigates perceived barriers towards the implementation of multiprofessional team briefings (MPTB) in operating theatres, as well as ways to overcome these perceived barriers. Previous research shows that MPTB can enhance teamwork and communication, but are underused in operating theatres. By adopting a multilevel systems perspective, this study examines perceived barriers and solutions for MPTB implementation. Design Participants completed open-ended survey questions. R...
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#1Megan Delisle (UM: University of Manitoba)H-Index: 4
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BACKGROUND: The Surgical Safety Checklist (SSC) is a patient safety tool shown to reduce mortality and to improve teamwork and adherence with perioperative safety practices. The results of the original pilot work were published 10 years ago. This study aimed to determine the contemporary prevalence and predictors of SSC use globally. METHODS: Pooled data from the GlobalSurg and Surgical Outcomes studies were analysed to describe SSC use in 2014-2016. The primary exposure was the Human Developmen...
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