Point prevalence of surgical checklist use in Europe: Relationship with hospital mortality

Jammer, I, Ahmad, T, Aldecoa, C, Koulenti, D, Goranovic, T, Grigoras, I, Mazul-Sunko, B, Matos, R, Moreno, R, Sigurdsson, G. H, Toft, P, Walder, B, Rhodes, A and Pearse, R. M (2015) Point prevalence of surgical checklist use in Europe: Relationship with hospital mortality. British Journal of Anaesthesia, 114 5: 801-807. doi:10.1093/bja/aeu460

Author Jammer, I
Ahmad, T
Aldecoa, C
Koulenti, D
Goranovic, T
Grigoras, I
Mazul-Sunko, B
Matos, R
Moreno, R
Sigurdsson, G. H
Toft, P
Walder, B
Rhodes, A
Pearse, R. M
Title Point prevalence of surgical checklist use in Europe: Relationship with hospital mortality
Journal name British Journal of Anaesthesia   Check publisher's open access policy
ISSN 1471-6771
Publication date 2015-01-13
Year available 2015
Sub-type Article (original research)
DOI 10.1093/bja/aeu460
Volume 114
Issue 5
Start page 801
End page 807
Total pages 7
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 2703 Anesthesiology and Pain Medicine
Formatted abstract
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.
Keyword Checklist
Hospital mortality
Outcome assessment (health care)
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 7 times in Thomson Reuters Web of Science Article | Citations
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