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

(2018) BRITISH JOURNAL OF ANAESTHESIA. 120(1). p.146-155
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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; 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.
Keywords
WORLD-HEALTH-ORGANIZATION, PREOPERATIVE HEART-RATE, WARNING SCORE NEWS, ADVERSE EVENTS, POSTOPERATIVE COMPLICATIONS, HOSPITAL MORTALITY, IMPLEMENTATION, MORBIDITY, EUROPE, cohort studies, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical, procedures

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Citation

Please use this url to cite or link to this publication:

Chicago
Abbott, TEF, T Ahmad, MK Phull, AJ Fowler, R Hewson, BM Biccard, MS Chew, et al. 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.
APA
Abbott, T., Ahmad, T., Phull, M., Fowler, A., Hewson, R., Biccard, B., Chew, M., et al. (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.
Vancouver
1.
Abbott T, Ahmad T, Phull M, Fowler A, Hewson R, Biccard B, et al. The surgical safety checklist and patient outcomes after surgery : a prospective observational cohort study, systematic review and meta-analysis. BRITISH JOURNAL OF ANAESTHESIA. 2018;120(1):146–55.
MLA
Abbott, TEF, T Ahmad, MK Phull, et al. “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 (2018): 146–155. Print.
@article{8573091,
  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 {\textrangle}= 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{\textlangle}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{\textlangle}0.01; I-2 = 87\%] and reduced complication rates [OR 0.73 (0.61-0.88); P{\textlangle}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.},
  author       = {Abbott, TEF and Ahmad, T and Phull, MK and Fowler, AJ and Hewson, R and Biccard, BM and Chew, MS and Gillies, M and Pearse, RM and International Surgical Outcomes Study (ISOS) group, for the and Abeloos, Jacques and Bouchez, Stefaan and Coppens, Marc and De Baerdemaeker, Luc and DEBLAERE, ISABEL and De Bruyne, Ann and De Hert, Stefan and Fonck, Kristine and Heyse, Bjorn and JACOBS, TOM and Lapage, Koen and Moerman, Anneliese and Neckebroek, Martine and Parashchanka, Aliaksandra and ROELS, NATHALIE and Van Den Eynde, Nancy and Vandenheuvel, Micha{\"e}l and Van Limmen, Jurgen and Vanluchene, Ann and Vanpeteghem, Caroline and Wouters, Patrick and WYFFELS, PIET},
  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  language     = {eng},
  number       = {1},
  pages        = {146--155},
  title        = {The surgical safety checklist and patient outcomes after surgery : a prospective observational cohort study, systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1016/j.bja.2017.08.002},
  volume       = {120},
  year         = {2018},
}

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