Haynes and colleagues tested whether introducing the WHO 19‑item Surgical Safety Checklist would lower deaths and complications after noncardiac surgery in hospitals of varied economic settings.
Prospective before‑and‑after study of 7688 consecutive patients aged 16 or older having noncardiac surgery at 8 hospitals in 8 cities, October 2007 to September 2008.
The authors hypothesized that a program introducing a 19‑item checklist aimed at team communication and consistent care would lower surgical complications and deaths.
Methods
Design
Prospective before‑and‑after cohort
October 2007 to September 2008
Data source
8 hospitals in 8 cities
WHO Safe Surgery Saves Lives program
Varied economic circumstances
Patients
7688 consecutive patients
Age 16 or older
Noncardiac surgery
Exposure
Baseline period: 3733 patients
After checklist introduction: 3955 patients
Follow-up
In hospital, up to 30 days after surgery
Outcomes
Primary: complications including death
Adherence to six safety process measures
Surgical‑site infection
Unplanned reoperation
Pneumonia
Key Findings
Inpatient complications fell from 11.0% before the checklist to 7.0% after (p < 0.001), and deaths fell from 1.5% to 0.8% (p = 0.003).
Complications fell significantly at both high‑income sites (10.3% to 7.1%) and lower‑income sites (11.7% to 6.8%), each p < 0.001.
The drop in deaths was significant at lower‑income sites (2.1% to 1.0%, p = 0.006) but not at high‑income sites (0.9% to 0.6%, p = 0.18).
All six measured safety steps were completed in 56.7% of patients after the checklist, up from 34.2% at baseline (p < 0.001).
Surgical‑site infection (p < 0.001) and unplanned reoperation (p = 0.047) also fell significantly, while pneumonia did not change (p = 0.46).
The effect on death or complications stayed significant when any single site was dropped from the model (p < 0.05).
Board pearl
Because it compared consecutive patients before and after introduction without randomization, this study links the checklist to concurrent falls in deaths and complications but does not prove it caused them.
Authors' conclusion
Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
Haynes and colleagues tested whether introducing the WHO 19‑item Surgical Safety Checklist would lower deaths and complications after noncardiac surgery in hospitals of varied economic settings.
Prospective before‑and‑after study of 7688 consecutive patients aged 16 or older having noncardiac surgery at 8 hospitals in 8 cities, October 2007 to September 2008.
The authors hypothesized that a program introducing a 19‑item checklist aimed at team communication and consistent care would lower surgical complications and deaths.
Methods
Design
Prospective before‑and‑after cohort
October 2007 to September 2008
Data source
8 hospitals in 8 cities
WHO Safe Surgery Saves Lives program
Varied economic circumstances
Patients
7688 consecutive patients
Age 16 or older
Noncardiac surgery
Exposure
Baseline period: 3733 patients
After checklist introduction: 3955 patients
Follow-up
In hospital, up to 30 days after surgery
Outcomes
Primary: complications including death
Adherence to six safety process measures
Surgical‑site infection
Unplanned reoperation
Pneumonia
Key Findings
Inpatient complications fell from 11.0% before the checklist to 7.0% after (p < 0.001), and deaths fell from 1.5% to 0.8% (p = 0.003).
Complications fell significantly at both high‑income sites (10.3% to 7.1%) and lower‑income sites (11.7% to 6.8%), each p < 0.001.
The drop in deaths was significant at lower‑income sites (2.1% to 1.0%, p = 0.006) but not at high‑income sites (0.9% to 0.6%, p = 0.18).
All six measured safety steps were completed in 56.7% of patients after the checklist, up from 34.2% at baseline (p < 0.001).
Surgical‑site infection (p < 0.001) and unplanned reoperation (p = 0.047) also fell significantly, while pneumonia did not change (p = 0.46).
The effect on death or complications stayed significant when any single site was dropped from the model (p < 0.05).
Board pearl
Because it compared consecutive patients before and after introduction without randomization, this study links the checklist to concurrent falls in deaths and complications but does not prove it caused them.
Authors' conclusion
Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.