General surgery

The researches find that the Implementation of the World Health Organization (WHO) Surgical Safety Checklist at surgical centers in England led to a 37.2% relative reduction (from 1.21 to 0.76) in inpatient postoperative mortality during the years after implementation, a study has found. Therefore “The checklist has been demonstrate to reduce postoperative mortality rates (POMR) at an individual patient level; but this is the first evidence for its potential to improve outcomes at a national level;” the researchers write.

Surgical Safety Checklist

The study, by Dmitri Nepogodiev, MBChB, from the National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham; but United Kingdom, and colleagues are publish online June 25 in a research letter in the British Journal of Surgery. “With an estimated 4.2 million people worldwide dying within 30 days of surgery each year, identification of strategies to reduce postoperative mortality has been identify as a global research priority;” they explain.

Previous population research in Scotland find that use of the checklist result in a 39% relative reduction in inpatient POMRs from 2000 to 2014. Therefore The checklist is phase in from 2008 to 2010 as part of the Scottish Patient Safety Programme. In the Birmingham study, investigators sought to replicate those findings.

Reduce postoperative mortality

“Most of the estimated 4.2 million postoperative deaths each year occur in low- and middle-income countries; where the WHO checklist is often inconsistently used;” Nepogodiev told Medscape Medical News. Because The 16 years from 1998 to 2014 saw a general downward trend in postoperative deaths, with a more than 30% relative reduction in POMR across all specialties except otorhinolaryngology, cardiology, colorectal oncology; and plastic surgery.

In England, which already had low baseline POMRs, the greatest decrease was observed in the 2 years preceding checklist implementation in 2008. During that period; therefore there was an absolute POMR reduction of 0.71% per year; after which the annual pace of decrease fell. The greatest reductions occurred in esophagogastric (68.8%) and breast surgery (69.3%).

Plastic and cardiac surgery

During the implementation and postimplementation periods, 10 of 14 specialties had a better than 5% relative reduction in POMRs; POMRs remained stable in plastic and cardiac surgery and increased in obstetrics and otorhinolaryngology. The study data cannot explain why some specialties saw no decline in POMRs.

“One key factor that may contribute to this is changes in case mix, such as age of patients, how many other medical conditions patients have, how frail they are, what type of surgery they are having. We have not controlled for in this study,” Nepogodiev explained. The greatest benefit has been seen in patients undergoing emergency surgery in low- and middle-income countries.