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, M K Phull, A J Fowler, R Hewson, B M Biccard, M S Chew, M Gillies, R M Pearse*, International Surgical Outcomes Study (ISOS) group

*Corresponding author for this work

Research output: Contribution to journalArticle

29 Citations (Scopus)

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<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.

Original languageEnglish
Pages (from-to)146-155
Number of pages10
JournalBritish Journal of Anaesthesia
Volume120
Issue number1
Early online date13 Dec 2017
DOIs
Publication statusPublished - Jan 2018

Keywords

  • Adult
  • Aged
  • Checklist
  • Cohort Studies
  • Elective Surgical Procedures/standards
  • Evidence-Based Medicine
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Patient Safety
  • Postoperative Complications/epidemiology
  • Postoperative Period
  • Surgical Procedures, Operative/methods
  • Treatment Outcome

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  • Cite this

    Abbott, T. E. F., Ahmad, T., Phull, M. K., Fowler, A. J., Hewson, R., Biccard, B. M., Chew, M. S., Gillies, M., Pearse, R. M., & International Surgical Outcomes Study (ISOS) group (2018). The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. British Journal of Anaesthesia, 120(1), 146-155. https://doi.org/10.1016/j.bja.2017.08.002