The World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events.
This systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased.
The quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations.
The checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.
World Health Organization Patient safety (2014) Safe Surgery Saves Lives Frequently Asked Questions (updated September 2014) http://www.who.int/patientsafety/safesurgery/faq_introduction/en/
Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. International journal for quality in health care : journal of the International Society for Quality in Health Care/ISQua 14:269–276 CrossRef
Alnaib M, Al Samaraee A, Bhattacharya V (2012) The WHO surgical safety checklist. J Perioper Pract 22:289–292 PubMed
Center for Geographic Analysis, Harvard University (2014) WHO Patient safety: Surgical Safety Web map (updated September 2014). http://maps.cga.harvard.edu/surgical_safety/index.html
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 10:287–294
Biskup N, Workman AD, Kutzner E, et al. (2015) Perioperative safety in plastic surgery: is the World Health Organization Checklist useful in a broad practice? Ann Plast Surg
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):W264 CrossRef
Davenport DL, Henderson WG, Mosca CL et al (2007) Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg 205:778–784 CrossRefPubMed
The World Bank Group (2015). http://data.worldbank.org/country
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 16:20–25
Mayer EK, Sevdalis N, Rout S, et al. (2015) Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation: A Longitudinal Study. Ann Surg
Morgan L, Hadi M, Pickering S, et al. (2015) The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: A controlled interrupted time series study. BMJ Open 5
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 21:376–378
Yuan CT, Walsh D, Tomarken JL et al (2012) Incorporating the World Health Organization Surgical Safety Checklist into practice at two hospitals in Liberia. Joint Commission J Qual Patient Saf 38:254–260
Vats A, Vincent CA, Nagpal K et al (2010) Practical challenges of introducing WHO surgical checklist: UK pilot experience. BMJ 340:133–135 CrossRef
Borgi J, Rubinfeld I, Ritz J et al (2013) The differential effects of intermediate complications with postoperative mortality. Am Surg 79:261–266 PubMed
Kelly SP, Steeples LR, Smith R et al (2013) Surgical checklist for cataract surgery: progress with the initiative by the Royal College of Ophthalmologists to improve patient safety. Eye (Basingstoke) 27:878–882
- Postoperative Adverse Events Inconsistently Improved by the World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies
Elzerie de Jager
- Springer International Publishing
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