Effect of Adherence to the World Health Organization Surgical Safety Checklist on Morbidity and Mortality in a Defined Surgical Patient Population

ABSTRACT

To improve patient safety and prevent complications, WHO introduced surgical safety checklist (WHO SSC). However, the actual effect of WHO SSC on patient morbidity, particularly surgical site infections (SSI), and mortality on post-operative patients is one of the least studied area. Our study was to measure the effects surgical safety checklists have in reducing morbidities and complications, particularly surgical site infections, post-operative length of stay and mortality resulting from the surgical procedures. Methods: A prospective observational comparative study was conducted among all patients who underwent elective general surgical procedures from 01st July 2015 to 30th June 2016 in the Main OT Complex (OT1 and OT2), Indoor Surgical Wards and higher dependency units (ITU & CCU) of IPGMER & SSKM Hospital, Kolkata, after applying proper exclusion criteria. Pre-implementation (before implementation of WHO Surgical Safety Checklist) data was collected for first 6 months, then WHO Surgical Safety Checklist was implemented over next 6 months. Pre and post-implementation cohorts were compared and analysed. Results: Total 382 patients (187 Control group and 195 implementation group) were included. Both groups matched regarding age, sex, type of surgery, type of anaesthesia, post-operative length of stay. However, incidence of SSI significantly decreased (30.48% to 16.41%, p value 0.002, <0.05, statistically significant). Overall complication rate, unplanned return to operating room (OR) also decreased though the results were statistically not significant. Conclusion: Implementation of WHO SSC decreases morbidity related to SSI significantly. Further studies are required to assess the effects on mortality and unplanned return to OR.