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

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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.

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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.

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Authors and Affiliations

  1. College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

    Elzerie de Jager

  2. Research and Development Unit, Primary Health Care and Dental Care, Narhalsan, Southern Älvsborg county, Region Västra Götaland, Sweden

    Ronny Gunnarsson

  3. Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Ronny Gunnarsson

  4. Discipline of Surgery, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia

    Yik-Hong Ho

  5. Townsville Clinical School, The Townsville Hospital, Townsville, QLD, 4814, Australia

    Elzerie de Jager

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  1. Elzerie de Jager
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  2. Ronny Gunnarsson
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  3. Yik-Hong Ho
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Correspondence to Elzerie de Jager.

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de Jager, E., Gunnarsson, R. & Ho, YH. Implementation of the World Health Organization Surgical Safety Checklist Correlates with Reduced Surgical Mortality and Length of Hospital Admission in a High-Income Country. World J Surg 43, 117–124 (2019). https://doi.org/10.1007/s00268-018-4703-x

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  • DOI: https://doi.org/10.1007/s00268-018-4703-x

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