engleski

Point prevalence of surgical checklist use in Europe: Relationship with hospital mortality

Background The prevalence of use of the World Health Organisation surgical checklist is unknown. The clinical effectiveness of this intervention in improving post-operative outcomes is debated. Methods Retrospective analysis of data describing surgical checklist use from a seven day cohort study of surgical outcomes in 28 European nations (European Surgical Outcomes Study, EuSOS). The analysis included hospitals recruiting more than ten patients and excluding outlier hospitals above the 95th centile for mortality. Multivariate logistic regression and three-level hierarchical generalised mixed models were constructed to explore the relationship between surgical checklist use and hospital mortality. Findings are presented as crude and adjusted odds ratios (OR) with 95% confidence intervals (CI). Results A total of 45, 591 patients from 426 hospitals were included in the analysis. A surgical checklist was used in 67.5% patients with marked variation between countries (0-99.6% of patients). Surgical checklist exposure was associated with lower crude hospital mortality (OR 0.84 [CI 0.75 to 0.94] ; p=0.002). This effect remained after adjustment for baseline risk factors in a multivariate model (adjusted OR 0.81 [CI 0.70 to 0.94] ; p<0.005) and strengthened after adjusting for variations within countries and hospitals in a three-level generalised mixed model (adjusted OR 0.71 [CI 0.58 to 0.85] ; p<0.001). Conclusion The use of surgical checklists varies between European nations. Exposure to a checklist was associated with lower mortality. This observation may represent a protective effect of the surgical checklist itself, or alternatively this intervention may be an indirect indicator of quality of peri-operative care.

Checklist ; Outcome Assessment (Health Care) ; Hospital Mortality

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