Effect of Using a Safety Checklist on Patient Complications after Surgery: A Systematic Review and Meta-analysis

Background:Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods:A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results:Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P < 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion:Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

[1]  R. Reznick,et al.  Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice , 2011, Quality and Safety in Health Care.

[2]  B. Walder,et al.  Dexamethasone for the Prevention of Postoperative Nausea and Vomiting: A Quantitative Systematic Review , 2000, Anesthesia and analgesia.

[3]  G. Liumbruno,et al.  Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. , 2011, Blood transfusion = Trasfusione del sangue.

[4]  Michael W Kattan,et al.  Meta-analysis: Its strengths and limitations. , 2008, Cleveland Clinic journal of medicine.

[5]  D. Schwappach,et al.  A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery , 2012, Annals of surgery.

[6]  M. Makary,et al.  Operating room briefings: working on the same page. , 2006, Joint Commission journal on quality and patient safety.

[7]  A. Fourcade,et al.  Barriers to staff adoption of a surgical safety checklist , 2011, BMJ quality & safety.

[8]  M. Makuuchi,et al.  Scenario 1 : Complication After a Surgical Procedure Not Caused by a Surgeon , 2022 .

[9]  T H Kappen,et al.  Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality: A Cohort Study , 2012, Annals of surgery.

[10]  M. Askarian,et al.  Effect of Surgical Safety Checklists on Postoperative Morbidity and Mortality Rates, Shiraz, Faghihy Hospital, a 1-Year Study , 2011, Quality management in health care.

[11]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[12]  A. Bleakley,et al.  Improving teamwork climate in operating theatres:The shift from multiprofessionalismto interprofessionalism , 2006, Journal of interprofessional care.

[13]  B. Gillespie,et al.  Team communications in surgery – creating a culture of safety , 2013, Journal of interprofessional care.

[14]  David S Shapiro,et al.  Thirty-day outcomes support implementation of a surgical safety checklist. , 2012, Journal of the American College of Surgeons.

[15]  C. Nazar,et al.  [Effects on blood glucose of prophylactic dexamethasone for postoperative nausea and vomiting in diabetics and non-diabetics]. , 2011, Revista medica de Chile.

[16]  Stuart R. Lipsitz,et al.  Effect of A 19-Item Surgical Safety Checklist During Urgent Operations in A Global Patient Population , 2010, Annals of surgery.

[17]  J. Vender,et al.  Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy: Effect on In-hospital and Postdischarge Recovery Outcomes , 2011, Anesthesiology.

[18]  K. Slim,et al.  Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument , 2003, ANZ journal of surgery.

[19]  S. Flottorp,et al.  Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. , 2005, The Cochrane database of systematic reviews.

[20]  R. McCarthy,et al.  Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-analysis of Randomized Controlled Trials , 2011, Anesthesiology.

[21]  Daniel Low,et al.  Implementing checklists in the operating room , 2012, Paediatric anaesthesia.

[22]  G R Baker,et al.  Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR , 2005, Quality and Safety in Health Care.

[23]  Marianne Wallis,et al.  The impact of organisational and individual factors on team communication in surgery: a qualitative study. , 2010, International journal of nursing studies.

[24]  E. Bradley,et al.  Incorporating the World Health Organization Surgical Safety Checklist into practice at two hospitals in Liberia. , 2012, Joint Commission journal on quality and patient safety.

[25]  G. Liumbruno,et al.  Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period. , 2011, Blood transfusion = Trasfusione del sangue.

[26]  P. Pronovost,et al.  Clinical review: Checklists - translating evidence into practice , 2009, Critical care.

[27]  B. Spiess The Use of Checklists as a Method to Reduce Human Error in Cardiac Operating Rooms , 2013, International anesthesiology clinics.

[28]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. , 2010, International journal of surgery.

[29]  D. Polit,et al.  Statistics and Data Analysis for Nursing Research , 2009 .

[30]  D. Gouma,et al.  What is a Surgical Complication? , 2008, World Journal of Surgery.

[31]  Peter J Pronovost,et al.  Framework for Patient Safety Research and Improvement , 2009, Circulation.

[32]  M. Makary,et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. , 2006, Journal of the American College of Surgeons.

[33]  W. Berry,et al.  A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population , 2009, The New England journal of medicine.

[34]  S. Galandiuk,et al.  Systematic reviews and meta‐analysis for the surgeon scientist , 2006, The British journal of surgery.

[35]  E. Copeland,et al.  A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population , 2010 .

[36]  Thomas G Weiser,et al.  Review article: Perioperative checklist methodologies , 2013, Canadian Journal of Anesthesia/Journal canadien d'anesthésie.

[37]  B. Levack,et al.  Use of the WHO surgical safety checklist in trauma and orthopaedic patients , 2011, International Orthopaedics.

[38]  J. Treadwell,et al.  Surgical checklists: a systematic review of impacts and implementation , 2013, BMJ quality & safety.

[39]  J. Higgins Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .