article · British journal of surgery
A global investigation evaluated the use of the World Health Organization Surgical Safety Checklist in emergency surgery and its link to patient mortality. Analysing data from 12,296 patients across 76 countries, the work focused on 4,843 adults undergoing emergency laparotomy compared with elective gastrointestinal procedures. Reported checklist adoption varied widely by development level, with 89.6 per cent use in high Human Development Index nations, falling to 60.6 per cent in middle-index and 42.2 per cent in low-index nations. Checklist use was linked to a significant reduction in 30-day perioperative mortality overall. The largest absolute survival benefits were identified in emergency operations within low- and middle-index countries, precisely where reported routine use remains lowest.
Emergency abdominal surgery carries a high risk of death, especially in lower-resource settings. Demonstrating that a simple safety checklist substantially reduces perioperative mortality provides clear justification for healthcare systems and hospitals worldwide to enforce its adoption in urgent operations.
The abstract does not indicate a commercial application pathway, as it evaluates the implementation of an existing, non-proprietary World Health Organization clinical protocol within hospital surgical practices.
AI-generated from the published abstract. Always read the original work before citing.
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 per cent; 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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DOI: 10.1002/bjs.11051
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