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Original Investigation |

A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital ONLINE FIRST

Matthias Bock, MD, Priv Doz1,2,3; Antonio Fanolla, MS4; Isabelle Segur-Cabanac, MD1; Franco Auricchio, MD1; Carla Melani, MS4; Flavio Girardi, MD5; Horand Meier, MD6; Armin Pycha, MD7
[+] Author Affiliations
1Department of Anesthesiology and Intensive Care Medicine I, Bolzano Central Hospital, Bolzano, Italy
2Department of Anesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria
3Currently with Department of Anesthesiology and Intensive Care Medicine, Merano Hospital “Franz Tappeiner,” Merano, Italy
4Epidemiologic Observatory, Department of Health, Province of Bolzano, Bolzano, Italy
5Hospital Management, Bolzano Central Hospital, Bolzano, Italy
6Clinical Governance, Department of Health, Province of Bolzano, Bolzano, Italy
7Department of Urology, Bolzano Central Hospital, Bolzano, Italy
JAMA Surg. Published online February 03, 2016. doi:10.1001/jamasurg.2015.5490
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Importance  The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear.

Objective  To assess the association between the implementation of SSCs and all-cause 90- and 30-day mortality rates.

Design, Setting, and Participants  Evaluation of the outcomes of surgical procedures performed during the 6 months before (January 1 to June 30, 2010) and after (January 1 to June 30, 2013) the introduction of SSCs by retrospective analysis of administrative databases. The study was conducted in a public, regional, university-affiliated hospital in Italy. Data were collected from October 23, 2013, to November 12, 2014, including 90-day all-cause mortality, 30-day all-cause mortality, length of hospital stay, and 30-day readmission rate among patients undergoing noncardiac surgery. Patients undergoing surgery during the 6-month periods before and after the implementation of SSCs were compared. Data were analyzed from September 17, 2014, to July 31, 2015.

Main Outcomes and Measures  Risk-adjusted rates of 90- and 30-day mortality, readmission rate, and length of stay.

Results  The total study sample of 10 741 patients included 5444 preintervention and 5297 postintervention patients (5093 [47.4%] male and 5648 [52.6%] female patients; mean [SD] age, 53.0 [23.0] years). Ninety-day all-cause mortality was 2.4% (129 patients) before compared with 2.2% (118 patients) after the SSC implementation, for an adjusted odds ratio (AOR) of 0.73 (95% CI, 0.56-0.96; P = .02). Thirty-day all-cause mortality was 1.36% (74 patients) before compared with 1.32% (70 patients) after the SSC implementation, for an AOR of 0.79 (95% CI, 0.56-1.11; P = .17). Thirty-day readmission occurred in 797 patients (14.6%) in the preimplementation group vs 766 patients (14.5%) in the postimplementation group, for an AOR of 0.90 (95% CI, 0.81-1.01; P = .79). The adjusted length of stay was 10.4 (95% CI, 10.3-10.6) days in the preimplementation group compared with 9.6 (95% CI, 9.4-9.7) days in the postimplementation group (P < .001).

Conclusions and Relevance  The data cannot prove causality owing to the study design. The implementation of SSCs was associated with a 27% reduction of the adjusted risk for all-cause death within 90 days but not within 30 days. The adjusted length of stay was reduced after implementation of SSCs.

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Figure 1.
90-Day All-Cause Mortality

Forest plot shows adjusted odds ratios (AORs) for the single characteristics of the patients and type of admission, preintervention vs postintervention, with weighting of the data by inverse probability of treatment.

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Figure 2.
30-Day All-Cause Mortality

Forest plot shows adjusted odds ratios (AORs) for the single characteristics of the patients and type of admission, preintervention vs postintervention, with weighting of the data by inverse probability of treatment.

Graphic Jump Location

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