A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes
Bruce M Biccard, Reitze Rodseth, Larissa Cronje, Peter Agaba, Edson Chikumba, Leon Du Toit, Zane Farina, Stephanie Fischer, P Dean Gopalan, Komalan Govender, Jayd Kanjee, Aidan Kingwill
(+7 others)
2016
South African Medical Journal
Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality [1, 2] and surgical complications. [1] [2] [3] [4] The importance of these findings is difficult to interpret, however, [1] as these meta-analyses contain little randomised evidence, [1, 3, 4] with a single randomised trial of 65 patients [5] included in some of the meta-analyses. There are currently no meta-analyses of the efficacy of the SSC from
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... omised controlled trials (RCTs). Despite the compelling observational data supporting SSCs, and national policy directives mandating the use of an SSC, the uptake and implementation of SSCs has been poor. [6] Improving implemen tation of the SSC requires local checklist champions, staff checklist training, and improving feedback to reduce checklist redundancies. [7, 8] A higher level of evidence supporting SSCs, such as that from a large RCT or a meta-analysis of RCTs, may be necessary before SSCs are actively championed and successfully implemented. [8] This is important, as data suggest that correct implementation with checklist completion is more successful than partial checklist completion at reducing surgical complications. [9] Objective The objective of this meta-analysis was to determine the efficacy of the SSC in RCTs. Using the participants, interventions, comparisons, outcomes and study design (PICOS) method, [10] we described the participants as all categories of surgical patients, the intervention as the use of an SSC, and the comparison as the usual (or standard) operating room management. The primary outcome was mortality. Secondary outcomes included perioperative complications, which were defined as surgical complications, anaesthetic complications, length of stay and cost. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [10] in conducting this metaanalysis. Protocol and registration A full protocol was not developed for this meta-analysis. The metaanalysis was registered with PROSPERO (CRD42015017546). Background. Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications. Objective. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). Methods. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine. Results. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 -0.85; p=0.0004; I 2 =0%) and surgical complications (RR 0.64, 95% CI 0.57 -0.71; p<0.00001; I 2 =0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 -1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 -1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 -1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 -0.56; p<0.00001. Conclusions. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent.
doi:10.7196/samj.2016.v106i6.9863
pmid:27245725
fatcat:ki3izkyu7naafdqgldrajdmklq
