title: A Comparative Effectiveness Analysis of the Implementation of Surgical Safety Checklists in a Tertiary Care Hospital.
abstract: 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.
  
  
  
  To assess the association between the implementation of SSCs and all-cause 90- and 30-day mortality rates.
  
  
  
  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.
  
  
  
  Risk-adjusted rates of 90- and 30-day mortality, readmission rate, and length of stay.
  
  
  
  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 < .001).
  
  
  
  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.
authors: Department of Anesthesiology and Intensive Care Medicine I, Bolzano Central Hospital, Bolzano, Italy2Department of Anesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria3Currently with Department of Ane.
authors: Matthias
authors: M
authors: Bock
authors: Epidemiologic Observatory, Department of Health, Province of Bolzano, Bolzano, Italy.
authors: Antonio
authors: A
authors: Fanolla
authors: Department of Anesthesiology and Intensive Care Medicine I, Bolzano Central Hospital, Bolzano, Italy.
authors: Isabelle
authors: I
authors: Segur-Cabanac
authors: Department of Anesthesiology and Intensive Care Medicine I, Bolzano Central Hospital, Bolzano, Italy.
authors: Franco
authors: F
authors: Auricchio
authors: Epidemiologic Observatory, Department of Health, Province of Bolzano, Bolzano, Italy.
authors: Carla
authors: C
authors: Melani
authors: Hospital Management, Bolzano Central Hospital, Bolzano, Italy.
authors: Flavio
authors: F
authors: Girardi
authors: Clinical Governance, Department of Health, Province of Bolzano, Bolzano, Italy.
authors: Horand
authors: H
authors: Meier
authors: Department of Urology, Bolzano Central Hospital, Bolzano, Italy.
authors: Armin
authors: A
authors: Pycha
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D057189:Checklist; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019990:Perioperative Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data*; D015996:Survival Rate; D062606:Tertiary Care Centers; D013997:Time Factors