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المؤلفون: Abbott, T. E. F., Ahmad, T., Phull, M. K., Fowler, A. J., Hewson, R., Biccard, B. M., Chew, Michelle, Gillies, M., Pearse, R. M.
المصدر: British Journal of Anaesthesia. 120(1):146-155
مصطلحات موضوعية: cohort studies, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical procedures
الوصف: Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained amp;gt;= 1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); Pamp;lt;0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P = 0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); Pamp;lt;0.01; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); Pamp;lt;0.01; I-2 = 89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
وصف الملف: print
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المؤلفون: Davies, J. I., Gelb, A. W., Gore-Booth, J., Mellin-Olsen, J., Martin, J., Akerman, C., Ameh, E. A., Biccard, B. M., Braut, G. S., Chu, K. M., Derbew, M., Ersdal, H. L., Guzman, J. M., Hagander, L., Haylock-Loor, C., Holmer, H., Johnson, W., Juran, S., Kassebaum, N. J., Laerdal, T., Leather, A. J. M., Lipnick, M. S., Ljungman, David, Makasa, E. M. M., Meara, J. G., Newton, M. W., Ostergaard, D., Reynolds, T., Romanzi, L. J., Santhirapala, V., Shrime, M. G., Soreide, K., Steinholt, M., Suzuki, E., Varallo, J. E., Visser, G. H. A., Watters, D., Weiser, T. G.
المصدر: Plos Medicine. 18(8)
مصطلحات موضوعية: Surgery, Kirurgi, australian-resuscitation-council, international liaison committee, american-heart-association, recommended guidelines, political priority, stroke-foundation, health, cardiopulmonary, statement, outcomes, General & Internal Medicine
الوصف: Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. Conclusions To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
الوصول الحر: https://gup.ub.gu.se/publication/307381Test
