06 Jun Properly Implemented Safe Surgery Checklists Can Save Lives

MedicalResearch.com Interview with:
Dr. Janet Martin PharmD, PhD
Director, Medical Evidence, Decision Integrity & Clinical Impact (MEDICI)
Assistant Professor, Department of Anesthesia & Perioperative Medicine
and Department of Epidemiology & Biostatistics
Schulich School of Medicine & Dentistry, Western University
London, ON Canada

Medical Research: What is the background for this study? What are the main findings?

Response: There remains some scepticism regarding the effectiveness of the safe surgery checklist (SSCL) to tangibly improve patient safety in the real world setting, especially with respect to relative benefits in high-income versus lower-income settings.

In general, push-back has been related to surgical teams doubting the power of a simple checklist to make significant impact for surgical settings. Despite their deceptive simplicity, checklists can be powerful tools to deal with the sheer volume of information that must be addressed in sequence in order to support safe surgery.

The objective of our study was to determine, through meta-analysis, whether clinically-relevant outcomes after implementation of the WHO Safe Surgery Checklist (SSCL) in the clinical trial setting and in the real world setting are improved, and whether greater benefit occurs in low-middle income countries (LMICs) than in high income countries (HICs).

A total of 13 studies (262,970 patients) met the inclusion criteria, including 12 cohort studies and 1 randomized trial. For SSCL versus control, the odds of death was significantly reduced by 21% (OR 0.79, 95%CI 0.67-0.93; p=0.003). The odds of surgical site infection was reduced by 28% (OR 0.72, 95%CI 0.62-0.84; p=0.001). Similarly, overall postoperative complications were significantly reduced by 30% (OR 0.70, 95%CI 0.59-0.82; p=0.009). While HIC and LMICs both experienced reductions in death, surgical site infections, and overall complications, the magnitude of reduction was generally greater for LMICs than in HICs. Sub-analysis by study design demonstrated generalizability between the clinical trial setting and the real world setting.

Medical Research: What should clinicians and patients take away from your report?

Response: The magnitude of reduction in risk of  death and serious complications in our study demonstrates that the safe surgery checklist, if properly implemented, could save more lives worldwide than any other single known intervention.

This is something we need to take seriously, as it is feasible and effective in all settings, and costs little, and impacts on the outcomes we care most about: death, complications, and infections.

It also aligns fully with the new priorities established at the World Health Assembly last week in Geneva. Delegates of the World Health Assembly passed the historic resolution “to strengthen emergency and essential surgery care”, which puts a renewed global energy toward ensuring surgery is available, and can be performed safety, in all parts of the world  (WHA resolution A 68/31). The safe surgery checklist will help realize this dream.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Future research should focus on moving the science forward. Since we already have sufficient studies addressing the question of whether the safe surgery checklist works, the scientific community should now move their research efforts toward defining how to implement the checklist effectively (how to garner surgical team buy-in and accountability; how to ensure institutional and leadership support; and how to sustain the benefits over the long-term).

Additionally, studies should evaluate whether the checklist content is ideal in its current form, or whether the contents should be expanded or revised as technologies and techniques advance over time.

Citation:

The safe surgery checklist could save more lives worldwide than any other single known intervention If properly implemented

Research presented at this year’s Euroanaesthesia meeting in Berlin

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MedicalResearch.com Interview with: Dr. Janet Martin PharmD, PhD, & Director, Medical Evidence, Decision Integrity & Clinical Impact (MEDICI) (2015). Properly Implemented Safe Surgery Checklists Can Save Lives

Last Updated on June 6, 2015 by Marie Benz MD FAAD