New Delhi: Implementation of World Health Organization's Surgical Safety Checklist should be made mandatory in India and the developing world as it significantly reduces postoperative morbidity and mortality, states a recent study.
More than 234 million surgical operations are performed annually worldwide, and it has been estimated that at least half of the complications that occur are avoidable.
"It is the first such randomized controlled study from any developing country which shows that implementation of checklist can significantly bring down the postoperative complications ultimately improving the outcome," said Dr Samiran Nundy, Author of the study and Emeritus Consultant, Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital (SGRH).
The study, which got published in the journal of Gastrointestinal Surgery on February 18, was performed on 700 consecutive patients undergoing a surgical procedure between February 2012 and April 2013.
Two groups were made- in both the groups, a hospital checklist (used in all patients before operation in our hospital) was filled in by the nurses. In half of the patients, in addition to the hospital checklist, a modified WHO checklist was implemented and the results were compared with a control group of another 350 patients.
The checklist was used on three occasions--before anaesthesia (sign in), before the skin incision (time out) and before the patient was shifted out of the operating room (sign out)."In the study, the implementation of a modified WHO surgical safety checklist was associated with a decrease in mortality and number of complications. The mortality was significantly lower in the modified WHO checklist group which had a mortality rate of 5.7 per cent compared to 10 per cent in the other group where this checklist was not used," said Dr Neeraj Chaudhary, corresponding author of study and clinical assistant, Department of Surgical Gastroenterology and Liver Transplantation SGRH.
"This is the first study, to our knowledge, which has shown improved results with checklist implementation in a prospective randomized controlled trial from a developing country. Improved results after checklists have also been shown by previous studies, but all of these were in a cohort setting and from the developed world," said Dr Chaudhary.
Our results are comparable to another prospective study done in 2009 and published in New England Journal of Medicine wherein using WHO checklist in eight hospitals in different cities across the globe over 1 year on about 4000 patients, a substantial reduction in both mortality as well as complication rate were noticed, said Dr Chaudhary.
According to Dr Nundy, surgical complications are a major cause of morbidity and mortality and also pose a major financial burden to patients and providers.
"This is especially relevant in a developing country like India where there is a lack of resources and more than three fourths of the population pays out of their pocket for health expenses," said Dr Nundy.
According to WHO, while surgical procedures are intended to save lives, unsafe surgical care can cause substantial harm. Given the ubiquity of surgery, this has significant implications in industralised countries, nearly half of all adverse events in hospitalized patients are related to surgical care, and at least half of the cases in which surgery led to harm are considered preventable.
WHO's multinational initiative in 2007, entitled 'Safe Surgery Saves Lives' clearly demonstrated a decrease in morbidity and mortality related to surgery.