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

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GlobalSurg Collaborative , Thomas , H S , Sallinen , V , Tolonen , M , Mentula , P , Leppäniemi , A , Sallinen , V & Koskenvuo , L 2019 , ' Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy ' , British Journal of Surgery , vol. 106 , no. 2 , pp. E103-E112 . https://doi.org/10.1002/bjs.11051 , https://doi.org/10.1002/bjs.11051

Title: Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
Author: GlobalSurg Collaborative; Thomas, Hannah S.; Sallinen, Ville; Tolonen, Matti; Mentula, Panu; Leppäniemi, Ari; Sallinen, Ville; Koskenvuo, Laura
Contributor: University of Helsinki, Department of Anatomy
University of Helsinki, Faculty of Medicine
University of Helsinki, Clinicum
University of Helsinki, II kirurgian klinikka
University of Helsinki, Pertti Panula / Principal Investigator
University of Helsinki, Department of Surgery
Date: 2019-01
Language: eng
Number of pages: 10
Belongs to series: British Journal of Surgery
ISSN: 0007-1323
URI: http://hdl.handle.net/10138/298715
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 <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; 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.
Subject: SURGERY
IMPLEMENTATION
HEALTH
BARRIERS
3126 Surgery, anesthesiology, intensive care, radiology
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