Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy



Thomas, Hannah S, Weiser, Thomas G, Drake, Thomas M, Knight, Stephen R, Fairfield, Cameron, Ademuyiwa, Adesoji O, Aguilera, Maria Lorena, Alexander, Philip, Al-Saqqa, Sara W, Borda-Luque, Giuliano
et al (show 3435 more authors) (2019) Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy. BRITISH JOURNAL OF SURGERY, 106 (2). E103-E112.

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Abstract

<h4>Background</h4>The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy.<h4>Methods</h4>In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation.<h4>Results</h4>Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries.<h4>Conclusion</h4>Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

Item Type: Article
Uncontrolled Keywords: GlobalSurg Collaborative, Humans, Emergency Treatment, Digestive System Surgical Procedures, Laparotomy, Survival Rate, Cohort Studies, Prospective Studies, Adult, Aged, Middle Aged, World Health Organization, Female, Male, Checklist, Patient Safety, Elective Surgical Procedures
Depositing User: Symplectic Admin
Date Deposited: 31 May 2019 10:42
Last Modified: 14 Oct 2023 09:33
DOI: 10.1002/bjs.11051
Open Access URL: https://doi.org/10.1002/bjs.11051
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3043837