Annals of Surgery

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Annals of Surgery:
doi: 10.1097/SLA.0b013e31823779ae
Original Articles

Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality: A Cohort Study

van Klei, W. A. MD, PhD*; Hoff, R. G. MD, PhD*; van Aarnhem, E. E. H. L. MD; Simmermacher, R. K. J. MD, PhD; Regli, L. P. E. MD, PhD§; Kappen, T. H. MD*; van Wolfswinkel, L. MD, PhD*; Kalkman, C. J. MD, PhD*; Buhre, W. F. MD, PhD*; Peelen, L. M. PhD*,¶

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Objective: To evaluate the effect of implementation of the WHO's Surgical Safety Checklist on mortality and to determine to what extent the potential effect was related to checklist compliance.

Background: Marked reductions in postoperative complications after implementation of a surgical checklist have been reported. As compliance to the checklists was reported to be incomplete, it remains unclear whether the benefits obtained were through actual completion of a checklist or from an increase in overall awareness of patient safety issues.

Methods: This retrospective cohort study included 25,513 adult patients undergoing non-day case surgery in a tertiary university hospital. Hospital administrative data and electronic patient records were used to obtain data. In-hospital mortality within 30 days after surgery was the main outcome and effect estimates were adjusted for patient characteristics, surgical specialty and comorbidity.

Results: After checklist implementation, crude mortality decreased from 3.13% to 2.85% (P = 0.19). After adjustment for baseline differences, mortality was significantly decreased after checklist implementation (odds ratio [OR] 0.85; 95% CI, 0.73–0.98). This effect was strongly related to checklist compliance: the OR for the association between full checklist completion and outcome was 0.44 (95% CI, 0.28–0.70), compared to 1.09 (95% CI, 0.78–1.52) and 1.16 (95% CI, 0.86–1.56) for partial or noncompliance, respectively.

Conclusions: Implementation of the WHO Surgical Checklist reduced in-hospital 30-day mortality. Although the impact on outcome was smaller than previously reported, the effect depended crucially upon checklist compliance.

© 2012 Lippincott Williams & Wilkins, Inc.


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