World Journal of Surgery

, Volume 43, Issue 1, pp 117–124 | Cite as

Implementation of the World Health Organization Surgical Safety Checklist Correlates with Reduced Surgical Mortality and Length of Hospital Admission in a High-Income Country

  • Elzerie de JagerEmail author
  • Ronny Gunnarsson
  • Yik-Hong Ho
Original Scientific Report



The World Health Organization Surgical Safety Checklist (WHO SSC) has been widely implemented in an effort to decrease surgical adverse events. The effects of the checklist on postoperative outcomes have not previously been examined in Australia, and there is limited evidence on the effects of the checklist in the long term.


A retrospective review was conducted using administrative databases to examine the effects of the implementation of the checklist on postoperative outcomes. Data from 21,306 surgical procedures, performed over a 5-year time period at a tertiary care centre in Australia where the WHO SSC was introduced in the middle of this period, were analysed using multivariate logistic regression.


Postoperative mortality rates decreased from 1.2 to 0.92% [p = 0.038, OR 0.74 (0.56–0.98)], and length of admission decreased from 5.2 to 4.7 days (p = 0.014). The reduction in mortality rates reached significance at the 2–3 years post-implementation period [p = 0.017, OR 0.61 (0.41–0.92)]. The observed decrease in mortality rates was independent of the surgical procedure duration.


Implementation of the WHO SSC was associated with a statistically significant reduction in mortality and length of admission over a 5-year time period. This is the first study demonstrating a reduction in postoperative mortality after the implementation of the checklist in an Australian setting. In this study, a relatively longer period examined, comparative to previous international studies, may have allowed factors like surgical culture change to take effect.



This work is supported by the Australian Government Research Training Program Scholarship and the Avant Doctor in Training Research Scholarship. The authors thank Lynne Bartlett and Madeleine Nowak for reviewing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Elzerie de Jager
    • 1
    • 5
    Email author
  • Ronny Gunnarsson
    • 2
    • 3
  • Yik-Hong Ho
    • 4
  1. 1.College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
  2. 2.Research and Development UnitPrimary Health Care and Dental CareNarhalsanSweden
  3. 3.Department of Public Health and Community MedicineInstitute of Medicine, The Sahlgrenska Academy, University of GothenburgGothenburgSweden
  4. 4.Discipline of Surgery, College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
  5. 5.Townsville Clinical SchoolThe Townsville HospitalTownsvilleAustralia

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