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Multicenter Study
. 2009 Jan 29;360(5):491-9.
doi: 10.1056/NEJMsa0810119. Epub 2009 Jan 14.

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

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Free article
Multicenter Study

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Alex B Haynes et al. N Engl J Med. .
Free article

Abstract

Background: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.

Methods: Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.

Results: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).

Conclusions: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

Comment in

  • A surgical safety checklist.
    Martin IC, Mason M, Findlay G. Martin IC, et al. N Engl J Med. 2009 May 28;360(22):2372-3; author reply 2374-5. doi: 10.1056/NEJMc090417. N Engl J Med. 2009. PMID: 19474440 No abstract available.
  • A surgical safety checklist.
    McCambridge J, Kypri K, Elbourne DR. McCambridge J, et al. N Engl J Med. 2009 May 28;360(22):2373-4; author reply 2374-5. doi: 10.1056/NEJMc090417. N Engl J Med. 2009. PMID: 19484822 No abstract available.
  • A surgical safety checklist.
    Sanders RD, Jameson SS. Sanders RD, et al. N Engl J Med. 2009 May 28;360(22):2373; author reply 2374-5. doi: 10.1056/NEJMc090417. N Engl J Med. 2009. PMID: 19484823 No abstract available.
  • A surgical safety checklist.
    Levin DC. Levin DC. N Engl J Med. 2009 May 28;360(22):2374; author reply 2374-5. doi: 10.1056/NEJMc090417. N Engl J Med. 2009. PMID: 19484824 No abstract available.
  • Eur Urol. 2009 Aug;56(2):395
  • CAGS and ACS evidence based reviews in surgery. 32: Use of a surgical safety checklist to reduce morbidity and mortality.
    Latosinsky S, Thirlby R, Urbach D, Baxter NN, Brasel KJ, Brown CJ, Chaudhury P, Cutter CS, Divino C, Dixon E, Dubois L, Fitzgerald GW, Henteleff HJ, Kirkpatrick AW, Latosinsky S, MacLean A, Mastracci TM, McLeod RS, Morris A, Neumayer LA, Temple LR, McKenzie ME; Members of the Evidence Based Reviews in Surgery Group. Latosinsky S, et al. Can J Surg. 2010 Feb;53(1):64-6. Can J Surg. 2010. PMID: 20100416 Free PMC article. No abstract available.
  • [Check-lists: the letter and spirit].
    Marty J. Marty J. Ann Fr Anesth Reanim. 2011 Jun;30(6):467-8. doi: 10.1016/j.annfar.2011.03.027. Epub 2011 May 4. Ann Fr Anesth Reanim. 2011. PMID: 21546207 French. No abstract available.

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