Research

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

Bruce M Biccard, Reitze Rodseth, Larissa Cronje, Peter Agaba, Edson Chikumba, Leon du Toit, Zane Farina, Stephanie Fischer, P Dean Gopalan, Komalan Govender, Jayd Kanjee, Aidan Kingwill, Farai Madzimbamuto, Doreen Mashava, Busisiwe Mrara, Magesvaran Mudely, Ezile Ninise, Justiaan Swanevelder, Agnes Wabule

Abstract


Background. Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.

Objective. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs).

Methods. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.

Results. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64, 95% CI 0.57 - 0.71; p<0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 - 1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 - 1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 - 1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 - 0.56; p<0.00001.

Conclusions. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent.


Authors' affiliations

Bruce M Biccard, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Reitze Rodseth, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Clinical Department, Anaesthesia, Grey’s Hospital, Pietermaritzburg, South Africa

Larissa Cronje, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Peter Agaba, Department of Anaesthesia and Critical Care, School of Medicine, College of Health Sciences, Faculty of Medicine, Makerere University, Uganda

Edson Chikumba, Department of Anaesthesia and Critical Care Medicine, College of Health Sciences, Faculty of Medicine, University of Zimbabwe

Leon du Toit, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Zane Farina, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Clinical Department, Anaesthesia, Grey’s Hospital, Pietermaritzburg, South Africa

Stephanie Fischer, Dunkeld Anaesthetic Practice, Johannesburg, South Africa

P Dean Gopalan, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Komalan Govender, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Jayd Kanjee, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Aidan Kingwill, Department of Anaesthesiology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Farai Madzimbamuto, Department of Anaesthesia and Critical Care Medicine, College of Health Sciences, Faculty of Medicine, University of Zimbabwe

Doreen Mashava, Private Practice, Avenues Clinic, Harare, Zimbabwe

Busisiwe Mrara, Department of Anaesthesiology, Faculty of Medicine, Walter Sisulu University, Mthatha, Eastern Cape, South Africa

Magesvaran Mudely, Perioperative Research Group, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

Ezile Ninise, Department of Anaesthesiology, Faculty of Medicine, Walter Sisulu University, Mthatha, Eastern Cape, South Africa

Justiaan Swanevelder, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Agnes Wabule, Department of Anaesthesia and Critical Care, School of Medicine, College of Health Sciences, Faculty of Medicine, Makerere University, Uganda

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Keywords

Checklist; Surgery; Complications; Morbidity; Preoperative care; Safety

Cite this article

South African Medical Journal 2016;106(6):592-597. DOI:10.7196/SAMJ.2016.v106i6.9863

Article History

Date submitted: 2015-06-26
Date published: 2016-05-09

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