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The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis
Queen Mary Univ London, England.
Queen Mary Univ London, England.
Barts Hlth NHS Trust, England.
Guys and St Thomass NHS Fdn Trust, England.
Vise andre og tillknytning
2018 (engelsk)Inngår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, nr 1, s. 146-155Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

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 amp;gt;= 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); Pamp;lt;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); Pamp;lt;0.01; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); Pamp;lt;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.

sted, utgiver, år, opplag, sider
ELSEVIER SCI LTD , 2018. Vol. 120, nr 1, s. 146-155
Emneord [en]
cohort studies; operative/mortality; postoperative care/methods; postoperative care/statistics and numerical data; surgery; surgical procedures
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-149765DOI: 10.1016/j.bja.2017.08.002ISI: 000435989400028PubMedID: 29397122OAI: oai:DiVA.org:liu-149765DiVA, id: diva2:1233920
Merknad

Funding Agencies|Nestle Health Sciences; Medical Research Council/British Journal of Anaesthesia clinical research training fellowship; National Research Foundation rating grant; MRC

Tilgjengelig fra: 2018-07-20 Laget: 2018-07-20 Sist oppdatert: 2019-09-19

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