Checklist slashes surgical mortality, morbidity.(GYNECOLOGIC SURGERY)

The use of a simple safety checklist dramatically reduced mortality and morbidity in a study of more than 7,600 consecutive surgery patients in diverse clinical settings around the world, according to a published report. The 19-item checklist, which was based on the 2008 World Health Organization guidelines for improving the safety of surgical patients, cut the rate of postoperative complications by 36% on average, "and death rates fell by a similar amount," said Dr. Alex B. Haynes of the Harvard School of Public Health, Boston, and his associates in the Safe Surgery Saves Lives study.

The overall complication rate decreased from 11% at baseline to 7% after introduction of the checklist, and in-hospital mortality decreased from 1.5% to 0.8%. Overall rates of surgical site infection and unplanned reoperation also markedly declined. 'Applied on a global basis, this checklist program has the potential to prevent large numbers of deaths and disabling complications," they noted.

The medical literature suggests that at least half of all surgical complications are avoidable. The investigators designed the checklist and assessed its use in a prospective study at eight hospitals in North America, Europe, Asia, the Middle East, and Africa.

Each hospital identified one to four operating rooms to serve as study rooms. Consecutive inpatients undergoing non-cardiac surgery in those rooms were enrolled. The 3,733 patients who underwent surgery during a baseline period served as a comparison group for the 3,955 patients who underwent surgery after implementation of the checklist.

"The checklist consists of oral confirmation by surgical teams of the completion of the basic steps for ensuring safe delivery of anesthesia, prophylaxis against infection, effective teamwork, and other essential practices in surgery," and is used before anesthesia ...