The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Christine S. M. Lau, Ronald S. Chamberlain
2016 Surgical Science  
The incidence of in-hospital adverse events is about 10%, with a majority of these related to surgery, and nearly half considered preventable events. In attempts to improve patient safety, the World Health Organization (WHO) developed a checklist to be used at critical perioperative moments. This meta-analysis examines the impact of the WHO surgical safety checklist (SSC) on various patient outcomes. Methods: A comprehensive search of all published studies assessing the use of the WHO SSC in
more » ... f the WHO SSC in patients undergoing surgery was conducted. Studies using the WHO SSC in any surgical setting, with pre-implementation and post-implementation outcome data were included. The incidence of patient outcomes (total complications, surgical site infections, unplanned return to the operating room (OR) within 30 days, and overall mortality) and adherence to safety measures were analyzed. Results: 10 studies involving 51,125 patients (27,490 prior to implementation and 23,635 after implementation of the WHO SSC) were analyzed. The implementation of the WHO SSC significantly reduced the risk of total complications by 37.9%, surgical site infections by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increased adherence to safety measures including airway evaluation, use of pulse oximetry, prophylactic antibiotics when necessary, confirmation of patient name and surgical site, and sponge count was also observed. Conclusions: The use of the WHO SSC is associated with a significant reduction in post-operative complication rates and mortality. The WHO SSC is a valuable tool that should be universally implemented in all surgical centers and utilized in all surgical patients. A comprehensive search of all published studies evaluating the use of the WHO surgical safety checklist in pa-C. S. M. Lau, R. S. Chamberlain 208 tients undergoing surgery was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar from the time the WHO surgical safety checklist was introduced to the current time (2008-2016) (Figure 1) . Additional citations were searched, using the references of the articles retrieved from prior publications. The last search was conducted on January 18, 2016, and only articles written in English were considered. Keywords used in the search included combinations of "World Health Organization", "WHO", "surgical checklist", and "safety checklist". Inclusion criteria included the use of the WHO surgical safety checklist in its original form (without modifications) in any surgical setting, with pre-implementation and post-implementation outcome data. In case of duplicate publications, only the most recent and updated report of the clinical trial was included. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data Extraction Articles retrieved from the searches were assessed for eligibility, and data pertaining to patients, intervention, control groups, outcomes, and methodology, were abstracted. Primary clinical outcomes of interest included the incidences of various patient outcomes-total complications, SSIs, unplanned return to the OR within 30 days, and overall mortality. Total complications were defined as complications occurring prior to hospital discharge or the first 30 days of hospital stay according to the American College of Surgeons' National Surgical Quality Improvement Program: acute renal failure, bleeding requiring the transfusion of four or more units of red cells within the first 72 hours after surgery, cardiac arrest requiring cardiopulmonary resuscitation, coma of 24 hours or longer, deep vein thrombosis, myocardial infarction, unplanned intubation, ventilator use of 48 hours or more, pneumonia, pulmonary embolism, stroke, major disruption of wound, SSI, sepsis, septic shock, systemic inflammatory response syndrome, unplanned return to the OR, vascular graft failure, and death [13] . Adherence to safety measures (airway evaluation, use of pulse oximeter, presence of catheter lines, prophylactic antibiotics, confirmation of patient and surgical site, and sponge count) were also analyzed. Statistical Analysis For each trial, relative risk (RR) with a 95% confidence interval (95% CI) for incidence of total complications, SSIs, unplanned return to the OR within 30 days, and overall mortality were calculated. RR and 95% CI for
doi:10.4236/ss.2016.74029 fatcat:jt4qhx3ryva7rgl2f7vsy5qam4