@article{1527194063834810ab918c20b6adf1a4,
title = "The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis",
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; I2=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.",
keywords = "cohort studies, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical procedures",
author = "{the International Surgical Outcomes Study (ISOS) group} and Abbott, {T. E.F.} and T. Ahmad and Phull, {M. K.} and Fowler, {A. J.} and R. Hewson and Biccard, {B. M.} and Chew, {M. S.} and M. Gillies and Pearse, {Rupert M.} and Scott Beattie and Clavien, {Pierre Alain} and Nicolas Demartines and Fleisher, {Lee A.} and Mike Grocott and James Haddow and Andreas Hoeft and Peter Holt and Rui Moreno and Naomi Pritchard and Andrew Rhodes and Duminda Wijeysundera and Matt Wilson and Tahania Ahmed and Kirsty Everingham and Russell Hewson and Marta Januszewska and Phull, {Mandeep Kaur} and Richard Halliwell and Mark Shulman and Paul Myles and Werner Schmid and Michael Hiesmayr and Patrick Wouters and {de Hert}, Stefan and Suzana Lobo and Xiangming Fang and Lars Rasmussen and Emmanuel Futier and Matthieu Biais and Aur{\'e}lien Venara and Karem Slim and Michael Sander and Despoina Koulenti and Kostoula Arvaniti and Mathew Chan and Atul Kulkarni and Susilo Chandra and Aida Tantri and Emad Geddoa and Muntadhar Abbas",
note = "Funding Information: The ISOS study was funded through an unrestricted research grant from Nestle Health Sciences. T.E.F.A. is supported by a Medical Research Council/British Journal of Anaesthesia clinical research training fellowship. B.B. is funded by a National Research Foundation rating grant and an MRC (SA) self-initiated research grant. M.G. is a Chief Scientist Office (Scotland) NHS Research Scheme Clinician. R.P. is a UK National Institute for Health Research Professor. Funding Information: The ISOS study was funded through an unrestricted research grant from Nestle Health Sciences . T.E.F.A. is supported by a Medical Research Council /British Journal of Anaesthesia clinical research training fellowship. B.B. is funded by a National Research Foundation rating grant and an MRC (SA) self-initiated research grant. M.G. is a Chief Scientist Office (Scotland) NHS Research Scheme Clinician. R.P. is a UK National Institute for Health Research Professor. Publisher Copyright: {\textcopyright} 2017 British Journal of Anaesthesia",
year = "2018",
month = jan,
day = "1",
doi = "10.1016/j.bja.2017.08.002",
language = "English",
volume = "120",
pages = "146--155",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Elsevier Ltd",
number = "1",
}