The surgical safety checklist and patient outcomes after surgery

a prospective observational cohort study, systematic review and meta-analysis

for the International Surgical Outcomes Study (ISOS) group

Research output: Contribution to journalArticle

17 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 (US)
Pages (from-to)146-155
Number of pages10
JournalBritish Journal of Anaesthesia
Volume120
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Patient Safety
Checklist
Observational Studies
Meta-Analysis
Cohort Studies
Odds Ratio
Outcome Assessment (Health Care)
Quality of Health Care
Safety
Perioperative Care
Mortality
Hospital Mortality
Linear Models
Confidence Intervals

Keywords

  • cohort studies
  • operative/mortality
  • postoperative care/methods
  • postoperative care/statistics and numerical data
  • surgery
  • surgical procedures

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The surgical safety checklist and patient outcomes after surgery : a prospective observational cohort study, systematic review and meta-analysis. / for the International Surgical Outcomes Study (ISOS) group.

In: British Journal of Anaesthesia, Vol. 120, No. 1, 01.01.2018, p. 146-155.

Research output: Contribution to journalArticle

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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; 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.",
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author = "{for the International Surgical Outcomes Study (ISOS) group} and Abbott, {T. E.F.} and T. Ahmad and Phull, {M. K.} and Fowler, {A. J.} and R. Hewson and Biccard, {B. M.} and Chew, {M. S.} and M. Gillies and Pearse, {R. M.} and Pearse, {Rupert M.} and Scott Beattie and Clavien, {Pierre Alain} and Nicolas Demartines and Fleisher, {Lee A.} and Mike Grocott and James Haddow and Andreas Hoeft and Peter Holt and Rui Moreno and Naomi Pritchard and Andrew Rhodes and Duminda Wijeysundera and Matt Wilson and Tahania Ahmed and Kirsty Everingham and Russell Hewson and Marta Januszewska and Phull, {Mandeep Kaur} and Richard Halliwell and Mark Shulman and Paul Myles and Werner Schmid and Michael Hiesmayr and Patrick Wouters and {de Hert}, Stefan and Suzana Lobo and Xiangming Fang and Lars Rasmussen and Emmanuel Futier and Matthieu Biais and Aur{\'e}lien Venara and Karem Slim and Michael Sander and Despoina Koulenti and Kostoula Arvaniti and Mathew Chan and Atul Kulkarni and Susilo Chandra and Aida Tantri and Miriam Treggiari",
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T1 - The surgical safety checklist and patient outcomes after surgery

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AU - Abbott, T. E.F.

AU - Ahmad, T.

AU - Phull, M. K.

AU - Fowler, A. J.

AU - Hewson, R.

AU - Biccard, B. M.

AU - Chew, M. S.

AU - Gillies, M.

AU - Pearse, R. M.

AU - Pearse, Rupert M.

AU - Beattie, Scott

AU - Clavien, Pierre Alain

AU - Demartines, Nicolas

AU - Fleisher, Lee A.

AU - Grocott, Mike

AU - Haddow, James

AU - Hoeft, Andreas

AU - Holt, Peter

AU - Moreno, Rui

AU - Pritchard, Naomi

AU - Rhodes, Andrew

AU - Wijeysundera, Duminda

AU - Wilson, Matt

AU - Ahmed, Tahania

AU - Everingham, Kirsty

AU - Hewson, Russell

AU - Januszewska, Marta

AU - Phull, Mandeep Kaur

AU - Halliwell, Richard

AU - Shulman, Mark

AU - Myles, Paul

AU - Schmid, Werner

AU - Hiesmayr, Michael

AU - Wouters, Patrick

AU - de Hert, Stefan

AU - Lobo, Suzana

AU - Fang, Xiangming

AU - Rasmussen, Lars

AU - Futier, Emmanuel

AU - Biais, Matthieu

AU - Venara, Aurélien

AU - Slim, Karem

AU - Sander, Michael

AU - Koulenti, Despoina

AU - Arvaniti, Kostoula

AU - Chan, Mathew

AU - Kulkarni, Atul

AU - Chandra, Susilo

AU - Tantri, Aida

AU - Treggiari, Miriam

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N2 - 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.

AB - 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.

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KW - surgical procedures

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