ABSTRACT
Background: The incidence of in-hospital adverse events is about 10%,
with a majority of these related to surgery, and nearly half considered
preventable events. In attempts to improve patient safety, the World Health
Organization (WHO) developed a checklist to be used at critical perioperative
moments. This meta-analysis examines the impact of the WHO surgical safety
checklist (SSC) on various patient outcomes. Methods: A comprehensive search of
all published studies assessing the use of the WHO SSC in patients undergoing
surgery was conducted. Studies using the WHO SSC in any surgical setting, with
pre-implementation and post-implementation outcome data were included. The
incidence of patient outcomes (total complications, surgical site infections,
unplanned return to the operating room (OR) within 30 days, and overall
mortality) and adherence to safety measures were analyzed. Results: 10 studies
involving 51,125 patients (27,490 prior to implementation and 23,635 after
implementation of the WHO SSC) were analyzed. The implementation of the WHO SSC
significantly reduced the risk of total complications by 37.9%, surgical site
infections by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increased
adherence to safety measures including airway evaluation, use of pulse
oximetry, prophylactic antibiotics when necessary, confirmation of patient name
and surgical site, and sponge count was also observed. Conclusions: The use of
the WHO SSC is associated with a significant reduction in post-operative
complication rates and mortality. The WHO SSC is a valuable tool that should be
universally implemented in all surgical centers and utilized in all surgical
patients.