Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

GlobalSurg Collaborative

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

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 percent; 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.

Original languageEnglish (US)
Pages (from-to)e103-e112
JournalBritish Journal of Surgery
Volume106
Issue number2
DOIs
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
This work was funded by DFID/MRC/Wellcome Trust Joint Global Health Trial Development Grant (MR/N022114/1). A National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 17-0799) is supporting the establishment of surgical research units in a subset of contributing low-income countries. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR or UK Department of Health and Social Care. The study funder had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Funding Information:
This work was funded by DFID/MRC/Wellcome Trust Joint Global Health Trial Development Grant (MR/N022114/1). A National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 17-0799) is supporting the establishment of surgical research units in a subset of contributing low-income countries. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR or UK Department of Health and Social Care. The study funder had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Disclosure: The authors declare no conflict of interest.

Publisher Copyright:
© 2019 The Authors.

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