Point Prevalence of Surgical Checklist Use in Europe: Relationship with Hospital Mortality

• Autor(a) principal: Jammer, I
• Data de Publicação: 2015
• Outros Autores: Ahmad, T, Aldecoa, C, Koulenti, D, Goranović, T, Grigoras, I, Mazul-Sunko, B, Matos, R, Moreno, R, Sigurdsson, GH, Toft, P, Walder, B, Rhodes, A, Pearse, RM
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2729
• topic: Checklist; Cohort Studies; Europe; Female; Hospitals; Humans; Length of Stay; Male; Odds Ratio; Outcome Assessment (Health Care); Prevalence; Retrospective Studies; Risk Factors; Surgical Procedures, Operative; World Health Organization; Hospital Mortality; HSJ UCI

BACKGROUND: The prevalence of use of the World Health Organization surgical checklist is unknown. The clinical effectiveness of this intervention in improving postoperative outcomes is debated. METHODS: We undertook a retrospective analysis of data describing surgical checklist use from a 7 day cohort study of surgical outcomes in 28 European nations (European Surgical Outcomes Study, EuSOS). The analysis included hospitals recruiting >10 patients and excluding outlier hospitals above the 95th centile for mortality. Multivariate logistic regression and three-level hierarchical generalized mixed models were constructed to explore the relationship between surgical checklist use and hospital mortality. Findings are presented as crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). 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 across countries (0-99.6% of patients). Surgical checklist exposure was associated with lower crude hospital mortality (OR 0.84, CI 0.75-0.94; P=0.002). This effect remained after adjustment for baseline risk factors in a multivariate model (adjusted OR 0.81, CI 0.70-0.94; P<0.005) and strengthened after adjusting for variations within countries and hospitals in a three-level generalized mixed model (adjusted OR 0.71, CI 0.58-0.85; P<0.001). CONCLUSIONS: The use of surgical checklists varies across European nations. Reported use of a checklist was associated with lower mortality. This observation may represent a protective effect of the surgical checklist itself, or alternatively, may be an indirect indicator of the quality of perioperative care.