Br J Surg. 2019 Jan;106(2):e103-e112. doi: 10.1002/bjs.11051.
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.
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.
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.
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.
世界卫生组织（WHO）手术安全检查表已经推行了 10 年，促进了安全实践，但尚未在全球范围内评估其在急诊手术中的地位。本研究的目的是评估在紧急情况下报告的检查表使用情况，并检查其与接受紧急剖腹手术的患者围手术期死亡率之间的关系。
在两项多国家队列研究中，比较了接受紧急剖腹手术的成年人与接受择期胃肠手术的成年人。使用多变量逻辑回归和引导模拟确定报告的检查表使用与死亡率之间的关系。
来自 76 个国家的 12296 名患者中，有 4843 名接受了紧急剖腹手术。在调整了患者和疾病因素后，在高人类发展指数（HDI）国家（2741 名中的 2455 名，89.6%）接受紧急剖腹手术前使用检查表的情况比在中（1242 名中的 753 名，60.6%；优势比（OR）0.17，95%置信区间 0.14 至 0.21，P <0.001）或低（860 名中的 363 名，42.2%；OR 0.08，0.07 至 0.10，P <0.001）HDI 国家更常见。在高 HDI 国家，择期手术中检查表的使用比紧急剖腹手术中更常见（风险差异-9.4%（95%置信区间-11.9%至-6.9%）；P <0.001），但在低 HDI 国家则相反（+12.1%（+7.0%至+17.3%）；P <0.001）。在多变量模型中，检查表的使用与较低的 30 天围手术期死亡率相关（OR 0.60，0.50 至 0.73；P <0.001）。在低和中 HDI 国家，紧急手术的绝对获益最大。
在紧急剖腹手术中使用检查表与围手术期死亡率显著降低相关。在低 HDI 国家，检查表的使用是高 HDI 国家的一半。
