학술논문
The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis.
Document Type
Academic Journal
Author
Abbott TEF; William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK.; Ahmad T; William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK.; Phull MK; The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK.; Fowler AJ; Guys and St. Thomas's NHS Foundation Trust, London SE1 7EH, UK.; Hewson R; The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK.; Biccard BM; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Chew MS; Department of Anaesthesia and Intensive Care, Faculty of Medicine and Health Sciences, Linköping University, 58185 Linköping, Sweden.; Gillies M; Department of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Edinburgh EH48 3DF, UK.; Pearse RM; William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK. Electronic address: r.pearse@qmul.ac.uk.
Source
Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.
Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.
Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); P<0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); P<0.01; I2 =87%] and reduced complication rates [OR 0.73 (0.61-0.88); P<0.01; I 2 =89%).
Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
(Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.
Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); P<0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); P<0.01; I
Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
(Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)