Skip to main content
SpringerLink
Log in

Implementation of a Surgical Safety Checklist and Postoperative Outcomes: a Prospective Randomized Controlled Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

The implementation of a surgical safety checklist is said to minimize postoperative surgical complications. However, to our knowledge, no randomized controlled study has been done on the influence of checklists on postoperative outcomes in a developing country. We conducted a prospective randomized controlled study with parallel group study design of the implementation of WHO surgical safety checklist involving 700 consecutive patients undergoing operations in our hospital between February 2012 and April 2013. In 350 patients, the checklist was implemented with modifications—the Rc arm. The control group of 350 patients was termed the Rn arm. The checklist was filled in by a surgery resident, and only the participants in the study were blinded. Postoperative wound-related (p = 0.04), abdominal (p = 0.01), and bleeding (p = 0.03) complications were significantly lower in the Rc compared to the Rn group. The number of overall and higher-grade complications (Clavien-Dindo grades 3 and 4) per patient reduced from 0.97 and 0.33 in the Rn arm to 0.80 and 0.23 in the Rc arm, respectively. A significant reduction in mortality was noted in the Rc arm as compared to the Rn arm (p = 0.04). In a subgroup analysis, the number of overall and higher-grade complications per patient with incomplete checklists was higher than that with fully completed checklist group. Implementation of WHO surgical safety checklist results in a reduction in mortality as well as improved postoperative outcomes in a tertiary care hospital in a developing country.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet 2008; 372: 139-144.

    Article  PubMed  Google Scholar 

  2. Sewell M, Adebibe M, Jayakumar P, et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop 2011; 35: 897-901.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Gawande AA, Thomas EJ, Zinner MJ, et al. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 1999; 126: 66-75.

    Article  CAS  PubMed  Google Scholar 

  4. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 2008; 17: 216-223.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Provnost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725-2732.

    Article  Google Scholar 

  6. Birkmeyer JD. Strategies for improving surgical quality: checklists and beyond. N Engl J Med 2010; 363: 1963-1965.

    Article  CAS  PubMed  Google Scholar 

  7. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491-499.

    Article  CAS  PubMed  Google Scholar 

  8. Joint Commission. Sentinel events alert-5th December 2001. http://www.jointcommission.org/SentinelEvents/sentineleventsalert/sea-24.htm.

  9. Joint Commission. Sentinel events statistics-December 31, 2006. http://www.jointcommission.org/SentinelEvents/statistics.

  10. Vats A, Vincent CA, Nagpal K, et al. Practical challenges of introducing the WHO Surgical Checklist: UK pilot experience. Br Med J 2010; 340: b5433.

    Article  CAS  Google Scholar 

  11. de Vries EN, Prins HA, Crolla RM, et al. SURPASS Collaborative Group; Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363: 1928-1937.

    Article  PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    Article  CAS  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavein PA. Classification of Surgical Complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213.

    Article  PubMed Central  PubMed  Google Scholar 

  14. van Klei WA, Hoff RG, van Aarnhem EEHL, et al. Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality: A Cohort Study. Ann Surg 2012; 255: 44-49.

    Article  PubMed  Google Scholar 

  15. Borchard A, Schwappach D, Barbir A, Bezzola P. A Systematic Review of the Effectiveness, Compliance, and Critical Factors for Implementation of Safety Checklists in Surgery. Ann Surg 2012; 256: 925–933.

    Article  PubMed  Google Scholar 

  16. Haynes A, Weiser T, Berry W, et al. Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention. BMJ Qual Saf 2011; 20: 102–107.

    Article  PubMed  Google Scholar 

  17. Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am J Surg 2009; 197: 678-685.

    Article  PubMed  Google Scholar 

  18. Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006; 202: 746-752.

    Article  PubMed  Google Scholar 

  19. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304: 1693-1700.

    Article  CAS  PubMed  Google Scholar 

  20. Walker IA, Reshamwalla S, Wilson IH. Surgical safety checklists: do they improve outcomes? Br J Anaesth 2012; 109: 47-54.

    Article  CAS  PubMed  Google Scholar 

  21. de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: a multi-center study. J Thorac Cardiovasc Surg 2000; 119: 661-672.

    Article  PubMed  Google Scholar 

  22. Urbach DR, Govindarajan A, Saskin R et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014; 370: 1029-1038.

    Article  CAS  PubMed  Google Scholar 

  23. W-Dahl A, Robertsson O, Stefa’nsdo’ ttir A, Gustafson P, Lidgren L. Timing of preoperative antibiotics for knee arthroplasties: improving the routines in Sweden. Patient Saf Surg 2011; 5: 22.

  24. Weiser T, Haynes A, Dziekan G, et al. Effect of a 19-item surgical safety checklist during urgent operations in a global patient population. Ann Surg 2010; 251: 976-980.

    Article  PubMed  Google Scholar 

  25. Bosk CL, Dixon-Woods M, Goeschel CA, Pronovost PJ. Reality check for checklists. Lancet 2009; 374: 444-445.

    Article  PubMed  Google Scholar 

Download references

Funding

None

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Room No 1474, Casualty Block, Old Rajinder Nagar, New Delhi, 110060, India

    Neeraj Chaudhary, Vibha Varma, Sorabh Kapoor, Naimish Mehta, Vinay Kumaran & Samiran Nundy

Authors
  1. Neeraj Chaudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vibha Varma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sorabh Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naimish Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vinay Kumaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samiran Nundy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neeraj Chaudhary.

Additional information

Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India, is the department and institution at which the study was done.

The paper is not based on a previous communication to a society or meeting.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaudhary, N., Varma, V., Kapoor, S. et al. Implementation of a Surgical Safety Checklist and Postoperative Outcomes: a Prospective Randomized Controlled Study. J Gastrointest Surg 19, 935–942 (2015). https://doi.org/10.1007/s11605-015-2772-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-2772-9

Keywords

Search

Navigation