Use of a surgical safety checklist is associated with a reduction in all complications, and specifically with wound infection and blood loss.

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• Brigid M Gillespie, Wendy Chaboyer, Lukman Thalib, Melinda John, Nicole Fairweather, and Kellee Slater.
• From the National Health and Medical Research Council Research Centre of Research Excellence in Nursing, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Queensland, Australia (B.M.G., W.C.); Department of Community Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait (L.T.); Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Queensland, Australia (M.J.); Department of Anaesthetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (N.F.); and Department of Hepatobiliary, Liver Transplant and General Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia (K.S.).
• Anesthesiology. 2014 Jun 1;120(6):1380-9.

BackgroundPrevious before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients.MethodsA systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed.ResultsOf the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P < 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192).ConclusionNotwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

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