SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

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

Thomas, HS; Weiser, TG; Drake, TM; Knight, SR; Fairfield, C; Ademuyiwa, AO; Aguilera, ML; Alexander, P; Al-Saqqa, SW; Borda-Luque, G; et al. 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Lee, K; Cox, M; Farhan-Alanie, MMH; Callan, R; Chibuye, C; Ali, THA; Rekhis, S; Rommaneh, M; Halhouli, O; Sam, ZH; Ismail, L; Kalles, V; Pata, F; Nita, GE; Coccolini, F; Ansaloni, L; Pugliesi, TB; Pardo, G; Blanco, R; GlobalSurg Collaborative, (2019) Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy. BRITISH JOURNAL OF SURGERY, 106 (2). E103-E112. ISSN 0007-1323 https://doi.org/10.1002/bjs.11051
SGUL Authors: Sinha, Sidhartha

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Abstract

Background 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. Methods 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. Results 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. Conclusion 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
Additional Information: This is the peer reviewed version of the following article: , (2019), Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy. Br J Surg, 106: e103-e112, which has been published in final form at https://doi.org/10.1002/bjs.11051. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: 11 Medical And Health Sciences, Surgery
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC)
Journal or Publication Title: BRITISH JOURNAL OF SURGERY
ISSN: 0007-1323
Dates:
DateEvent
8 January 2019Published
15 October 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
MR/N022114/1Department for International Developmenthttp://dx.doi.org/10.13039/501100000278
MR/N022114/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MR/N022114/1Wellcome Trusthttp://dx.doi.org/10.13039/100004440
NIHR 17‐0799National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
Web of Science ID: WOS:000455102200014
URI: http://openaccess.sgul.ac.uk/id/eprint/110662
Publisher's version: https://doi.org/10.1002/bjs.11051

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