The Rowett Institute, University of Aberdeen, Aberdeen, UK.
Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
Br J Surg. 2019 Jul;106(8):1005-1011. doi: 10.1002/bjs.11151. Epub 2019 Apr 16.
The WHO Surgical Safety Checklist has been implemented widely since its launch in 2008. It was introduced in Scotland as part of the Scottish Patient Safety Programme (SPSP) between 2008 and 2010, and is now integral to surgical practice. Its influence on outcomes, when analysed at a population level, remains unclear.
This was a population cohort study. All admissions to any acute hospital in Scotland between 2000 and 2014 were included. Standardized differences were used to estimate the balance of demographics over time, after which interrupted time-series (segmented regression) analyses were performed. Data were obtained from the Information Services Division, Scotland.
There were 12 667 926 hospital admissions, of which 6 839 736 had a surgical procedure. Amongst the surgical cohort, the inpatient mortality rate in 2000 was 0·76 (95 per cent c.i. 0·68 to 0·84) per cent, and in 2014 it was 0·46 (0·42 to 0·50) per cent. The checklist was associated with a 36·6 (95 per cent c.i. -55·2 to -17·9) per cent relative reduction in mortality (P < 0·001). Mortality rates before implementation were decreasing by 0·003 (95 per cent c.i. -0·017 to +0·012) per cent per year; annual decreases of 0·069 (-0·092 to -0·046) per cent were seen during, and 0·019 (-0·038 to +0·001) per cent after, implementation. No such improvement trends were seen in the non-surgical cohort over this time frame.
Since the implementation of the checklist, as part of an overall national safety strategy, there has been a reduction in perioperative mortality.
自 2008 年推出以来，世界卫生组织手术安全检查表已广泛实施。它于 2008 年至 2010 年作为苏格兰患者安全计划（SPSP）的一部分在苏格兰推出，现已成为外科实践不可或缺的一部分。当从人群水平分析其对结果的影响时，结果仍不清楚。
这是一项人群队列研究。纳入 2000 年至 2014 年期间苏格兰任何一家急性医院的所有住院患者。使用标准化差异来估计随着时间推移的人口统计学平衡，之后进行了中断时间序列（分段回归）分析。数据来自苏格兰信息服务司。
共有 12667926 例住院患者，其中 6839736 例有手术。在手术队列中，2000 年的住院死亡率为 0.76%（95%可信区间 0.68%至 0.84%），2014 年为 0.46%（0.42%至 0.50%）。检查表与死亡率降低 36.6%（95%可信区间 -55.2%至 -17.9%）相关（P<0.001）。实施前死亡率每年下降 0.003%（95%可信区间 -0.017%至 +0.012%）；实施期间每年下降 0.069%（-0.092%至 -0.046%），实施后每年下降 0.019%（-0.038%至 +0.001%）。在此期间，非手术队列中没有出现这种改善趋势。
自从检查表作为国家整体安全战略的一部分实施以来，围手术期死亡率有所下降。
