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Background Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.
Methods Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.
Results The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).
Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.
Source Information
From the Harvard School of Public Health (A.B.H., T.G.W., W.R.B., A.A.G.), Massachusetts General Hospital (A.B.H.), and Brigham and Women's Hospital (S.R.L., A.A.G.) — all in Boston; University of California–Davis, Sacramento (T.G.W.); Prince Hamzah Hospital, Ministry of Health, Amman, Jordan (A.-H.S.B.); University of Washington, Seattle (E.P.D.); College of Medicine, University of the Philippines, Manila (T.H.); St. Stephen's Hospital, New Delhi, India (S.J.); St. Francis Designated District Hospital, Ifakara, Tanzania (P.L.K.); National Institute of Health–University of the Philippines, Manila (M.C.M.L.); University of Auckland and Auckland City Hospital, Auckland, New Zealand (A.F.M.); Imperial College Healthcare National Health Service Trust, London (K.M.); and University Health Network, University of Toronto, Toronto (R.K.R., B.T.).
This article (10.1056/NEJMsa0810119) was published at NEJM.org on January 14, 2009.
Address reprint requests to Dr. Gawande at the Department of Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at safesurgery{at}hsph.harvard.edu.
Related Letters:
A Surgical Safety Checklist
Martin I. C., Mason M., Findlay G., Sanders R. D., Jameson S. S., McCambridge J., Kypri K., Elbourne D. R., Levin D. C., Haynes A. B., Gawande A. A.
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N Engl J Med 2009;
360:2372-2375, May 28, 2009.
Correspondence
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