The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Abstract

Background: The incidence of in-hospital adverse events is about 10%, with a majority of these related to surgery, and nearly half considered preventable events. In attempts to improve patient safety, the World Health Organization (WHO) developed a checklist to be used at critical perioperative moments. This meta-analysis examines the impact of the WHO surgical safety checklist (SSC) on various patient outcomes. Methods: A comprehensive search of all published studies assessing the use of the WHO SSC in patients undergoing surgery was conducted. Studies using the WHO SSC in any surgical setting, with pre-implementation and post-implementation outcome data were included. The incidence of patient outcomes (total complications, surgical site infections, unplanned return to the operating room (OR) within 30 days, and overall mortality) and adherence to safety measures were analyzed. Results: 10 studies involving 51,125 patients (27,490 prior to implementation and 23,635 after implementation of the WHO SSC) were analyzed. The implementation of the WHO SSC significantly reduced the risk of total complications by 37.9%, surgical site infections by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increased adherence to safety measures including airway evaluation, use of pulse oximetry, prophylactic antibiotics when necessary, confirmation of patient name and surgical site, and sponge count was also observed. Conclusions: The use of the WHO SSC is associated with a significant reduction in post-operative complication rates and mortality. The WHO SSC is a valuable tool that should be universally implemented in all surgical centers and utilized in all surgical patients.

Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization’s Checklists in Surgery

“…he World Health Organization surgical safety checklist (WHO SSC), now used globally, has been found to reduce complications and mortality, [1][2][3][4][5][6] although negative findings have also been published. 7,8 Questions have been raised regarding whether negative results are due to a lack of emphasis on the implementation and local tailoring.…”

Ciclo Pdca Para Elaboração De Checklist De Segurança Cirúrgica

“…Esta investigação possibilitou a elaboração e avaliação do conteúdo e aplicabilidade do "Checklist de Segurança Cirúrgica Pré e Pós Operatório" (CSCPP), norteado pelos preceitos da OMS para segurança do paciente. Os resultados apontam para o estímulo à criação de listas de segurança para outros contextos de saúde, após avaliação positiva à segurança cirúrgica (13) .…”

“…Estudos brasileiros realizados em hospitais da região Nordeste, Sul e Sudeste avaliaram a adesão ao checklist, obtendo como resultados 91,5%, 60,8% e 89,85%, respectivamente (10)(11)(12) . A relação entre o uso do checklist e a redução de complicações e mortalidade cirúrgica (13) retrata a importância do uso desta ferramenta no ambiente cirúrgico, bem como a estruturação de políticas e de estratégias para mudanças comportamentais de profissionais de saúde.…”

Do Checklists Make a Difference? A Natural Experiment from Food Safety Enforcement

“…The core evidence stems from healthcare. Recent meta‐analyses and systematic reviews suggest a weakly positive effect of surgical checklists on postoperative outcomes (Bergs et al ; De Jager et al ; Gillespie et al ; Lau & Chamberlain ; Lyons & Popejoy ). The rigor of observational designs and estimated effects, however, varies considerably, with only a limited number of randomized controlled trials.…”