The risk of dying up to 90 days after surgery was reduced after a hospital introduced surgical safety checklists (SSCs), an Italian study has reported.
While patients had shorter stays at a test hospital in Italy, following the introduction of the SSCs, there was no association between the checklists and reduced risk of death within 30 days.
Led by Dr Matthias Bock, of Bolzano Central Hospital, Bolzano, the research team examined the outcomes of surgical procedures performed during the six months before and after the introduction of SSCs, which comprised between 17 and 24 items, at the unnamed hospital.
They collected data on 90-day all-cause mortality, 30-day all-cause mortality, length of hospital stay, and 30-day readmission rate among 10,741 patients who underwent non-cardiac surgery, 5,444 of whom were preintervention and 5,297 postintervention patients.
The team found 129 patients (2.4%), died within 90 days (90-day all-cause mortality) compared with 118 patients (2.2%) after the SSC was introduced.
However, 30-day all-cause mortality stood at 1.4% (74 patients) before SSC was introduced, compared with 1.3% (70 patients) after it was implemented.
When it came to 30-day readmission, there were 797 patients (14.6%) in the preimplementation group compared with 766 patients (14.5%) in the postimplementation group.
The adjusted length of stay was 10.4 days in the preimplementation group compared with 9.6 days in the postimplementation group.
“To our knowledge, this report is the first on the association of SSCs and 90-day all-cause mortality, which might be even more important than 30-day all-cause mortality,” says Dr Bock, whose study is published online by JAMA Surgery.
“Thirty-day all-cause mortality might fail to capture intermediate-term complications, such as anastomosis leakage or pulmonary embolism, which occur despite prophylaxis late after trauma or genitourinary and general surgery," the authors write.
"The observed decline in length of stay suggests potential cost savings after the implementation of SSCs. Further trials should address this hypothesis and the effect on quality of care owing to a reduction of the costs of complications or unplanned reoperations."
Bock M, Doz P et al. A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital. JAMA Surgery 3 February 2016; doi:10.1001/jamasurg.2015.5490
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