Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

GlobalSurg Collaborative

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

Original languageEnglish (US)
Pages (from-to)e103-e112
JournalBritish Journal of Surgery
Volume106
Issue number2
DOIs
StatePublished - Jan 1 2019

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Checklist
Laparotomy
Human Development
Emergencies
Safety
Mortality
Odds Ratio
Cohort Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy. / GlobalSurg Collaborative.

In: British Journal of Surgery, Vol. 106, No. 2, 01.01.2019, p. e103-e112.

Research output: Contribution to journalArticle

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title = "Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy",
abstract = "Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.",
author = "{GlobalSurg Collaborative} and Thomas, {H. S.} and Weiser, {T. G.} and Drake, {T. M.} and Knight, {S. R.} and C. Fairfield and Ademuyiwa, {A. O.} and Aguilera, {M. L.} and P. Alexander and Al-Saqqa, {S. W.} and G. Borda-Luque and A. Costas-Chavarri and F. Ntirenganya and Fitzgerald, {J. E.} and Fergusson, {S. J.} and J. Glasbey and Ingabire, {J. C.A.} and L. Isma{\"i}l and Salem, {H. K.} and Kojo, {A. T.T.} and Lapitan, {M. C.} and R. Lilford and Mihaljevic, {A. L.} and D. Morton and Mutabazi, {A. Z.} and D. Nepogodiev and Adisa, {A. O.} and R. Ots and F. Pata and T. Pinkney and Qureshi, {A. U.} and {la Medina}, {A. R.} and S. Rayne and Shaw, {C. A.} and S. Shu and R. Spence and N. Smart and S. Tabiri and A. Bhangu and Harrison, {E. M.} and A. Verjee and E. Runigamugabo and A. Altamini and J. Cornick and Z. Jaffry and C. Khatri and A. Kirby and M. Mohan and G. Recinos and K. S{\o}reide and N. Gobin",
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TY - JOUR

T1 - Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

AU - GlobalSurg Collaborative

AU - Thomas, H. S.

AU - Weiser, T. G.

AU - Drake, T. M.

AU - Knight, S. R.

AU - Fairfield, C.

AU - Ademuyiwa, A. O.

AU - Aguilera, M. L.

AU - Alexander, P.

AU - Al-Saqqa, S. W.

AU - Borda-Luque, G.

AU - Costas-Chavarri, A.

AU - Ntirenganya, F.

AU - Fitzgerald, J. E.

AU - Fergusson, S. J.

AU - Glasbey, J.

AU - Ingabire, J. C.A.

AU - Ismaïl, L.

AU - Salem, H. K.

AU - Kojo, A. T.T.

AU - Lapitan, M. C.

AU - Lilford, R.

AU - Mihaljevic, A. L.

AU - Morton, D.

AU - Mutabazi, A. Z.

AU - Nepogodiev, D.

AU - Adisa, A. O.

AU - Ots, R.

AU - Pata, F.

AU - Pinkney, T.

AU - Qureshi, A. U.

AU - la Medina, A. R.

AU - Rayne, S.

AU - Shaw, C. A.

AU - Shu, S.

AU - Spence, R.

AU - Smart, N.

AU - Tabiri, S.

AU - Bhangu, A.

AU - Harrison, E. M.

AU - Verjee, A.

AU - Runigamugabo, E.

AU - Altamini, A.

AU - Cornick, J.

AU - Jaffry, Z.

AU - Khatri, C.

AU - Kirby, A.

AU - Mohan, M.

AU - Recinos, G.

AU - Søreide, K.

AU - Gobin, N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

AB - Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P < 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.

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