• I Jammer, T Ahmad, C Aldecoa, D Koulenti, T Goranović, I Grigoras, B Mazul-Sunko, R Matos, R Moreno, G H Sigurdsson, P Toft, B Walder, A Rhodes, R M Pearse, and European Surgical Outcomes Study (EuSOS) group.
• Department of Clinical Medicine, University of Bergen, Bergen 5021, Norway Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen 5021, Norway.
• Br J Anaesth. 2015 May 1; 114 (5): 801-7.

BackgroundThe prevalence of use of the World Health Organization surgical checklist is unknown. The clinical effectiveness of this intervention in improving postoperative outcomes is debated.MethodsWe undertook a retrospective analysis of data describing surgical checklist use from a 7 day cohort study of surgical outcomes in 28 European nations (European Surgical Outcomes Study, EuSOS). The analysis included hospitals recruiting >10 patients and excluding outlier hospitals above the 95th centile for mortality. Multivariate logistic regression and three-level hierarchical generalized mixed models were constructed to explore the relationship between surgical checklist use and hospital mortality. Findings are presented as crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).ResultsA total of 45 591 patients from 426 hospitals were included in the analysis. A surgical checklist was used in 67.5% patients, with marked variation across countries (0-99.6% of patients). Surgical checklist exposure was associated with lower crude hospital mortality (OR 0.84, CI 0.75-0.94; P=0.002). This effect remained after adjustment for baseline risk factors in a multivariate model (adjusted OR 0.81, CI 0.70-0.94; P<0.005) and strengthened after adjusting for variations within countries and hospitals in a three-level generalized mixed model (adjusted OR 0.71, CI 0.58-0.85; P<0.001).ConclusionsThe use of surgical checklists varies across European nations. Reported use of a checklist was associated with lower mortality. This observation may represent a protective effect of the surgical checklist itself, or alternatively, may be an indirect indicator of the quality of perioperative care.Clinical Trial RegistrationThe European Surgical Outcomes Study is registered with ClinicalTrials.gov, number NCT01203605.© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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