A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital
Autor: | Horand Meier, Isabelle Segur-Cabanac, Matthias Bock, Antonio Fanolla, Flavio Girardi, Carla Melani, Armin Pycha, Franco Auricchio |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male Comparative Effectiveness Research medicine.medical_specialty Pediatrics Time Factors Comparative effectiveness research 030230 surgery Patient Readmission Perioperative Care Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Cause of Death Internal medicine Surgical safety medicine Humans Aged Retrospective Studies business.industry Mortality rate Incidence (epidemiology) Perioperative Odds ratio Length of Stay Middle Aged Tertiary care hospital Checklist Survival Rate Italy Surgical Procedures Operative 030220 oncology & carcinogenesis Female Surgery Risk adjusted mortality rate business |
Zdroj: | JAMA Surgery. 151:639 |
ISSN: | 2168-6254 |
Popis: | 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 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. |
Databáze: | OpenAIRE |
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