Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
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Version 1 2023-06-09, 04:32Version 1 2023-06-09, 04:32
journal contribution
posted on 2024-06-19, 19:24authored byHannah S Thomas, Thomas G Weiser, Thomas M Drake, Stephen R Knight, Cameron Fairfield, Adesoji O Ademuyiwa, Maria Lorena Aguilera, Philip Alexander, Sara W Al-Saqqa, Giuliano Borda-Luque, Ainhoa Costas-Chavarri, Faustin Ntirenganya, J Edward Fitzgerald, Stuart J Fergusson, James Glasbey, JC Allen Ingabire, Lawani Ismail, Hosni Khairy Salem, Anyomih Theophilus Teddy Kojo, Marie Carmela Lapitan, Richard Lilford, Andre L Mihaljevic, Dion Morton, Alphonse Zeta Mutabazi, Dmitri Nepogodiev, Adewale O Adisa, Riinu Ots, Francesco Pata, Thomas Pinkney, Tomas Poskus, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Sarah Rayne, Catherine A Shaw, Sebastian Shu, Richard Spence, Neil Smart, Stephen Tabiri, Aneel Bhangu, Ewen M Harrison, Azmina Verjee, Emmy Runigamugabo, Afnan Altamini, Jen Cornick, Zahra Jaffry, Chetan Khatri, Andrew Kirby, Midhun Mohan, Gustavo Recinos, Kjetil Soreide, Aneel Bhang, Neel Gobin, Ana Vega Freitas, Nigel Hall, Sung-Hee Kim, Ahmed Negida, Hosni Khairy, Stephen J Chapman, Alexis P Arnaud, Cutting Edge Manipal, Radhian Amandito, Marwan Shawki, Michael Hanrahan, Justas Zilinskas, April Camilla Roslani, Cheng Chun Goh, Gareth Irwin, Laura Luque, Hunain Shiwani, Afnan Altamimi, Mohammed Ubaid Alsaggaf, Jenifa Jeyakumar, Yucel Cengiz, Dmitri A Raptis, James C Glasbey, Maria Marta Modolo, Dushyant Iyer, Sebastian King, Tom Arthur, Sayeda Nazmum Nahar, Ade Waterman, Michael Walsh, Arnav Agarwal, Augusto Zani, Mohammed Firdouse, Tyler Rouse, Qinyang Liu, Juan Camilo Correa, Peep Talving, Mengistu Worku, Alexis Arnaud, Vassilis Kalles, Basant Kumar, Sunil Kumar, Roy Quek, Luca Ansaloni, Ahmed Altibi, Donatas Venskutonis, John Whitaker, Vanessa Msosa, Yong Yong Tew, Alexia Farrugia, Elaine Borg, Zineb Bentounsi, Tanzeela Gala, Ibrahim Al-Slaibi, Haya Tahboub, Osaid H Alser, Diego Romani, Sebestian Shu, Piotr Major, Aurel Mironescu, Matei Bratu, Amar Kourdouli, Aliyu Ndajiwo, Abdulaziz Altwijri, Ahmad Gudal, Al Faifi Jubran, Sam Seisay, Bettina Lieske, Irene Ortega, Kithsiri J Senanayake, Omar Abdulbagi, Dmitri Raptis, Yuksel Altinel, Chia Kong, Ella Teasdale, Michael Stoddart, Rakan Kabariti, Sukrit Suresh, Katherine Gash, Ragavan Narayanan, Mayaba Maimbo, Claudio Fermani, Ruben Balmaceda, Ewan Macdermid, Roxanne Chenn, Cheryl Ou Yong, Michael Edye, Martin Jarmin, Scott K D'amours, Daniel Youssef, Nicholas Phillips, Jason Brown, Robert George, Cherry Koh, Oliver Warren, Isaac Hanley, Marilla Dickfos, Clemens Nawara, Dietmar Ofner, Florian Primavesi, Ashrarur Rahman Mitul, Khalid Mahmud, Margub Hussain, Hafiz Hakim, Tapan Kumar, Antje Oosterkamp, Pamphile A Assouto, Ismail Lawani, Yacoubou Imorou Souaibou, Aung Kyaw Tun, Chean Leung Chong, Giridhar H Devadasar, Muhammad Rashid Minhas Qadir, Kyaw Phyo Aung, Lee Shi Yeo, Vanessa Dina Palomino Castillo, Monique Moron Munhoz, Gisele Moreira, Luiz Carlos Barros De Castro Segundo, Salim Anderson Khouri Ferreira, Maira Cassa Careta, Stella Binna Kim, Alexandre Venancio De Sousa, Alyne Daltri Lazzarini Cury, Gustavo Peixoto Soares Miguel, Ana Vega Carreiro De Freitas, Barbara Pereira Silvestre, Julia Guasti Pinto Vianna, Carolina Oliveira Felipe, Luis Alberto Valente Laufer, Fernanda Altoe, Luana Ayres Da Silva, Marina Luiza Pimenta, Thiago Fernandes Giuriato, Paulo Alves Bezerra Morais, Jessica Souza Luiz, Rafael Araujo, Juliana Menegussi, Marisa Leal, Caio Vinicius Barroso de Lima, Luiza Sarmento Tatagiba, Antonio Leal, Diogo Vinicius dos Santos, Gustavo Pereira Fraga, Romeo Lages Simoes, Simon Stock, Samuel Nigo, Juana Kabba, Tagang Ebogo Ngwa, James Brown, Georges Azzie, Sameer Kushwaha, Karen Bailey, Brian Cameron, Michael Livingston, Alexandre Horobjowsky, Dan L Deckelbaum, Tarek Razek, Boris Marinkovic, Eugenio Grasset, Nicole D'aguzan, Julio Jimenez, Roberto Macchiavello, Zhongtao Zhang, Wei Guo, Junyeong Oh, Fei Zheng, Irene Montes, Sebastian Sierra, Manuela Mendez, Maria Isabel Villegas, Maria Clara Mendoza Arango, Ivan Mendoza, Fred Alexander Naranjo Aristizaibal, Jaime Andres Montoya Botero, Victor Manuel Quintero Riaza, Jakeline Restrepo, Carlos Morales, Herman Cruz, Alejandro Munera, Robert Karlo, Edgar Domini, Jakov Mihanovic, Mihael Radic, Kresimir Zamarin, Nikica Pezelj, Manuel Hache-Marliere, Sylvia Batista Lemaire, Ruben Rivas, Ahmed Khyrallh, Ahamed Hassan, Gamal Shimy, Mohamed A Baky Fahmy, Ayman Nabawi, Mohamed Elfil, Mohamed Ghoneem, Muhammad El-Saied Ahmad Muhammad Gohar, Mohamed Asal, Mostafa Abdelkader, Mahmoud Gomah, Hayssam Rashwan, Mohamed Karkeet, Ahmed Gomaa, Amr Hasan, Ahmed Elgebaly, Omar Saleh, Ahmad Abdel Fattah, Abdullah Gouda, Abd Elrahman Elshafay, Abdalla Gharib, Ahmed Menshawy, Mohammed Hanafy, Abdullah Al-Mallah, Mahmoud Abdulgawad, Mohamad Baheeg, Mohammed Alhendy, Ibrahim AbdelFattah, Abdalla Kenibar, Omar Osman, Mostafa Gemeah, Ahmed Mohammed, Abdalrahman Adel, Abdelrahman Mohammed, Abdelrahman Sayed, Mohamed Abozaid, Ahmed Hafez El-Badri Kotb, Ali Amin Ahmed Ata, Mohammed Nasr, Abdelrahman Alkammash, Mohammed Saeed, Nader Abd El Hamid, Attia Mohamed Attia, Ahmed Abd El Galeel, Eslam Elbanby, Khalid Salah El-Dien, Usama Hantour, Omar Alahmady, Billal Mansour, Amr Muhammad Elkorashy, Emad Mohamed Saeed Taha, Kholod Tarek Lasheen, Salma Said Elkolaly, Nehal Yosri Elsayed Abdel-Wahab, Mahmoud Ahmed Fathi Abozyed, Ahmed Adel, Ahmed Moustafa Saeed, Gehad Samir El Sayed, Jehad Hassan Youssif, Soliman Magdy Ahmed, Nermeen Soubhy El-Shahat, Abd El-Rahman Hegazy Khedr, Abdelrhman Osama Elsebaaye, Mohamed Elzayat, Mohamed Abdelraheim, Ibrahim Elzayat, Mahmoud Warda, Khaled Naser El Deen, Abdelrhman Essam Elnemr, Omar Salah, Mohamed Abbas, Mona Rashad, Ibrahim Elzayyat, Dalia Hemeda, Gehad Tawfik, Mai Salama, Hazem Khaled, Mohamed Seisa, Kareem Elshaer, Abdelfatah Hussein, Mahmoud Elkhadrawi, Ahmed Mohamed Afifi, Osama Saadeldeen Ebrahim, Mahmoud Mohamed Metwally, Rowida Elmelegy, Diaa Moustafa Elbendary Elsawahly, Hisham Safa, Eman Nofal, Mohamed Elbermawy, Ahmed Abdelmotaleb Ghazy, Hisham Samih, Asmaa Abdelgelil, Sarah Abdelghany, Ahmed El Kholy, Metwally Aboraya, Fatma Elkady, Mahmoud Salma, Sarah Samy, Reem Fakher, Aya Aboarab, Ahmed Samir, Ahmed Sakr, Abdelrahman Haroun, Asmaa Abdel-Rahman Al-Aarag, Ahmed Elkholy, Sally Elshanwany, Esraa Ghanem, Ahmed Tammam, Ali Mohamed Hammad, Yousra El Shoura, Gehad El Ashal, Sarah Antar, Sara Mehrez, Mahmoud Abdelshafy, Maha Gamal Mohamad Hamad, Mona Hosh, Emad Abdallah, Basma Magdy, Thuraya Alzayat, Elsayed Gamaly, Hossam Elfeki, Amany Abouzahra, Shereen Elsheikh, Fatimah I Elgendy, Fathia Abd El-Salam, Osama Seifelnasr, Mohamed Ammar, Athar Eysa, Aliaa Sadek, Aliaa Gamal Toeema, Aly Nasr, Mohamed Abuseif, Hagar Zidan, Sara Abd Elmageed Barakat, Nadin Elsayed, Yasmin Abd Elrasoul, Ahmed Elkelany, Mohamed Sabry Ammar, Mennat-Allah Mustafa, Yasmin Hegazy, Mohamed Etman, Samar Saad, Mahmoud Alrahawy, Ahmed Raslan, Mahmoud Morsi, Ahmed Rslan, Ahmed Sabry, Hager Elwakil, Heba Shaker, Yasmin Abd-Elrasoul, Hussein El-Kashef, Mohamed Shaalan, Areej Tarek, Ayman Elwan, Ahmed Ragab Nayel, Mostafa Seif, Doaa Emadeldin, Mohamed Ali Ghonaim, Ahmad Almallah, Ahmed Fouad, Eman Adel Sayma, Ahmad Elbatahgy, Angham Solaiman El-Ma'doul, Ahmed Mosad, Hager Tolba, Diaa Eldin Abdelazeem Amin Elsorogy, Hassan Ali Mostafa, Amira Atef Omar, Ola Sherief Abd El Hameed, Ahmed Lasheen, Yasser Abd El Salam, Ashraf Morsi, Mohammed Ismail, Hager Ahmed El-badawy, Mohamed A Amer, Ahmed Sabry El-Hamouly
Abstract
Background
The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy.
Methods
In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation.
Results
Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries.
Conclusion
Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.