Impact of the Surgical Safety Checklist on Postoperative Clinical Outcomes in Gastrointestinal Tumor Patients

Yanbing Zhou, Hao Wang. Affiliated Hospital of Qingdao University

BACKGROUND: A 19-item Surgical Safety Checklist (SSC) was published by the World Health Organization in 2008 and was proved to reduce postoperative complications. It was issued by the National Health and Family Planning Commission of the People’s Republic of China in 2010. To date, however, the impact of SSC implementation in China has not been evaluated. The study was performed to evaluate the impact of the SSC on postoperative clinical outcomes in gastrointestinal tumor patients.

STUDY DESIGN: Between April 2007 and March 2013, 7209 patients with gastrointestinal tumor who underwent elective surgery at the Affiliated Hospital of Qingdao University were studied. Data on the clinical records and outcomes of 3238 consecutive surgeries prior to SSC implementation were retrospectively collected; data on another 3971 consecutive surgeries performed after implementation of the checklist system were prospectively collected. The clinical outcomes (including mortality, morbidity, readmission, reoperation, unplanned intervention and postoperative hospital stay) occurring within 30 days after operation were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to identify independent factors for postoperative complications.

RESULTS: The rates of morbidity prior to and after checklist implementation were 16.43% and 14.33% (P = 0.018), respectively. In-hospital mortality occurred in 0.46% of the patients surveyed at the baseline and in 0.18% of the patients after checklist implementation (P = 0.028). Median of postoperative hospital stay before checklist implementation was 1 day longer than that observed afterward (P < 0.001). Multivariable analysis demonstrated that the SSC was an independent factor influencing any postoperative complications (odds ratio=0.860; 95% CI, 0.750–0.988).

CONCLUSIONS: Implementation of the SSC could improve the clinical outcomes in gastrointestinal tumor patients undergoing general surgery in China.

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