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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 Jager
  • Ronny Gunnarsson
  • Yik-Hong Ho
Original Scientific Report

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Notes

Acknowledgements

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.

References

  1. 1.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144CrossRefGoogle Scholar
  2. 2.
    World Health Organization Patient Safety (2014) Safe surgery saves lives frequently asked questions (updated September 2014) http://who.int/patientsafety/safesurgery/faq_introduction/en/
  3. 3.
    Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276CrossRefGoogle Scholar
  4. 4.
    Alnaib M, Al Samaraee A, Bhattacharya V (2012) The WHO surgical safety checklist. J Perioper Pract 22:289–292CrossRefGoogle Scholar
  5. 5.
    Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499CrossRefGoogle Scholar
  6. 6.
    de Jager E, McKenna C, Bartlett L et al (2016) Postoperative adverse events inconsistently improved by the World Health Organization surgical safety checklist: a systematic literature review of 25 studies. World J Surg 40:1842–1858.  https://doi.org/10.1007/s00268-016-3519-9 CrossRefGoogle Scholar
  7. 7.
    Conley DM, Singer SJ, Edmondson L et al (2011) Effective surgical safety checklist implementation. J Am Coll Surg 212:873–879CrossRefGoogle Scholar
  8. 8.
    Russ SJ, Sevdalis N, Moorthy K et al (2015) A qualitative evaluation of the barriers and facilitators toward implementation of the WHO surgical safety checklist across hospitals in England. Ann Surg 261:81–91CrossRefGoogle Scholar
  9. 9.
    Russ S, Rout S, Sevdalis N et al (2013) Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg 258:856–871CrossRefGoogle Scholar
  10. 10.
    Sarah Whyte LL, Sherry Espin G, Baker Ross, Bohnen John, Orser Beverley A, Doran Diane, Reznick Richard, Regehr Glenn (2008) Paradoxical effects of interprofessional briefings on OR team performance. Cogn Technol Work 10:287–294Google Scholar
  11. 11.
    Gillespie BM, Chaboyer W, Thalib L et al (2014) Effect of using a safety checklist on patient complications after surgery: a systematic review and meta-analysis. Anesthesiology 120:1380–1389CrossRefGoogle Scholar
  12. 12.
    Kreder HJ, Deyo RA, Koepsell T et al (1997) Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington. J Bone Joint Surg Am 79:485–494CrossRefGoogle Scholar
  13. 13.
    Dimick JB, Birkmeyer JD, Upchurch GR Jr (2005) Measuring surgical quality: What’s the role of provider volume? World J Surg 29:1217–1221.  https://doi.org/10.1007/s00268-005-7989-4 CrossRefGoogle Scholar
  14. 14.
    Killeen SD, O’Sullivan MJ, Coffey JC et al (2005) Provider volume and outcomes for oncological procedures. Br J Surg 92:389–402CrossRefGoogle Scholar
  15. 15.
    Killeen SD, Andrews EJ, Redmond HP et al (2007) Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures. J Vasc Surg 45:615–626CrossRefGoogle Scholar
  16. 16.
    Lehman SJ, Baker RA, Aylward PE et al (2009) Outcomes of cardiac surgery in Indigenous Australians. Med J Aust 190:588–593Google Scholar
  17. 17.
    Borgi J, Rubinfeld I, Ritz J et al (2013) The differential effects of intermediate complications with postoperative mortality. Am Surg 79:261–266Google Scholar
  18. 18.
    Khan NA, Quan H, Bugar JM et al (2006) Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med 21:177–180CrossRefGoogle Scholar
  19. 19.
    Chaudhary N, Varma V, Kapoor S et al (2015) Implementation of a surgical safety checklist and postoperative outcomes: a prospective randomized controlled study. J Gastrointest Surg 19:935–942CrossRefGoogle Scholar
  20. 20.
    Weiser TG, Haynes AB, Dziekan G et al (2010) Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 251:976–980CrossRefGoogle Scholar
  21. 21.
    Prakash P, Baduni N, Sanwal MK, Sinha SR, Shekhar C (2014) Effect of World Health Organization surgical safety checklist on patient outcomes in a Tertiary Care Hospital of Delhi. Int Med J 21:376–378Google Scholar
  22. 22.
    Boaz M, Bermant A, Ezri T et al (2014) Effect of surgical safety checklist implementation on the occurrence of postoperative complications in orthopedic patients. Israel Med Assoc J 16:20–25Google Scholar
  23. 23.
    Haugen AS, Søfteland E, Almeland SK et al (2014) Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 261:821–828CrossRefGoogle Scholar
  24. 24.
    Yuan CT, Walsh D, Tomarken JL et al (2012) Incorporating the World Health Organization surgical safety checklist into practice at two hospitals in Liberia. Jt Comm J Qual Patient Saf 38:254–260CrossRefGoogle Scholar
  25. 25.
    Rodrigo-Rincon I, Martin-Vizcaino MP, Tirapu-Leon B et al (2015) The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study. Acta Anaesthesiol Scand 59:205–214CrossRefGoogle Scholar
  26. 26.
    Mayer EK, Sevdalis N, Rout S et al (2016) Surgical checklist implementation project: the impact of variable WHO checklist compliance on risk-adjusted clinical outcomes after national implementation: a longitudinal study. Ann Surg 263:58–63CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Elzerie de Jager
    • 1
    • 5
  • 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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