C. S. Lau1,3, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2New Jersey Medical School,Surgery,Newark, NJ, USA 3Saint George’s University,Grenada, Grenada, Grenada
Introduction: The incidence of in-hospital adverse events is about 10%, with a majority of these related to surgery, and nearly half of these considered preventable events. To improve patient safety, the World Health Organization (WHO) developed a checklist to be used at critical perioperative moments (induction, incision, and prior to the patient leaving the operating room (OR)). This meta-analysis examines the impact of the WHO surgical safety checklist on the incidences of overall complications, surgical site infections (SSI), unplanned return to the OR within 30 days, and overall mortality.
Methods: A comprehensive literature search of all published studies assessing the use of the WHO surgical safety checklist in patients undergoing surgery was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966-2015). Keywords searched included ‘World Health Organization’, ‘surgical checklist’, and ‘safety checklist’. Inclusion criteria were the use of the WHO surgical safety checklist in any surgical setting, with pre-implementation and post-implementation surgical outcome data. The incidence of various patient outcomes (total complications, SSIs, unplanned return to the OR within 30 days, and overall mortality) and adherence to safety measures (airway evaluation, use of pulse oximeter, presence of catheter lines, prophylactic antibiotics, confirmation of patient and surgical site, and sponge count) were analyzed.
Results: 10 studies involving 51,125 patients (27,490 prior to implementation and 23,635 patients after the implementation of the WHO surgical safety checklist) were analyzed. The implementation of the WHO surgical safety checklist significantly reduced the risk of total complications by 37.9% (RR = 0.621; 95%CI 0.519 – 0.742; p<0.001), SSIs by 45.5% (RR = 0.545; 95%CI 0.416 – 0.714; p<0.001), unplanned return to OR by 32.1% (RR = 0.679; 95%CI 0.484 – 0.954; p=0.025), and mortality by 15.3% (RR = 0.847; 95%CI, 0.752 – 0.954; p=0.006). There was also a significant increase in adherence to safety measures including airway evaluation, use of pulse oximetry, prophylactic antibiotics when necessary, confirmation of patient name and surgical site, and sponge count.
Conclusions: The use of the WHO surgical safety checklist is associated with a significant reduction in post-operative complications and mortality. The WHO surgical safety checklist is a valuable tool that should be universally implemented in all surgical centers and utilized in all surgical patients. Additional studies are required to determine optimal strategies for implementation of the WHO surgical safety checklist in different healthcare settings and countries.
