Postoperative Adverse Events Inconsistently Improved by the World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies

Abstract

BackgroundThe World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events.MethodThis systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased.ResultsThe quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations.ConclusionsThe checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.

Effect of implementation of a surgical safety checklist on perioperative and postoperative complications at an academic institution in North America

“…Baseline and perioperative variables were statistically compared between groups in which surgeries were performed with an SSC (SSC + ) and in which surgeries were performed without an SSC (SSC − ); for continuous variables that were nonnormal distributions, a Kruskal‐Wallis test was used. Categorical variables were compared between SSC + and SSC− groups by using χ or Fisher's exact tests. Binomial exact methods were used for calculation of 95% CI for proportions.…”

The Checklist: Recognize Limits, but Harness Its Power

“…In addition to the negative fi ndings just noted, 39 an earlier randomized trial reported a higher surgical site infection rate (45%) in the extended arm of the study versus 24% in the standard arm (P = .003). 40 So how do we reconcile such contrasting fi ndings related to the effectiveness of checklists?…”

Comparação das taxas de infecção cirúrgica após implantação do checklist de segurança

“…(10) A systematic review (13) published in 2016, involving 25 studies, demonstrated reduction of complications, mainly in developing countries.…”

“…Some studies have been published in recent years, (10,13) reporting the implementation of this global challenge and the impact on the reduction of complications, adverse events and mortality related to surgical care. Studies (14)(15)(16) performed in Brazil are predominantly experience reports of implementation, and assessment of adherence to the checklist; studies that demonstrated effectiveness in clinical outcomes with the implementation of this global challenge are limited.…”