Point prevalence of surgical checklist use in Europe: relationship with hospital mortality

Research output: Contribution to journalJournal articleResearchpeer-review


  • I Jammer
  • T Ahmad
  • C Aldecoa
  • D Koulenti
  • T Goranović
  • I Grigoras
  • B Mazul-Sunko
  • R Matos
  • R Moreno
  • G H Sigurdsson
  • P Toft
  • B Walder
  • A Rhodes
  • R M Pearse
  • European Surgical Outcomes Study (EuSOS) group

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BACKGROUND: The prevalence of use of the World Health Organization surgical checklist is unknown. The clinical effectiveness of this intervention in improving postoperative outcomes is debated.

METHODS: We undertook a retrospective analysis of data describing surgical checklist use from a 7 day cohort study of surgical outcomes in 28 European nations (European Surgical Outcomes Study, EuSOS). The analysis included hospitals recruiting >10 patients and excluding outlier hospitals above the 95th centile for mortality. Multivariate logistic regression and three-level hierarchical generalized mixed models were constructed to explore the relationship between surgical checklist use and hospital mortality. Findings are presented as crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: A total of 45 591 patients from 426 hospitals were included in the analysis. A surgical checklist was used in 67.5% patients, with marked variation across countries (0-99.6% of patients). Surgical checklist exposure was associated with lower crude hospital mortality (OR 0.84, CI 0.75-0.94; P=0.002). This effect remained after adjustment for baseline risk factors in a multivariate model (adjusted OR 0.81, CI 0.70-0.94; P<0.005) and strengthened after adjusting for variations within countries and hospitals in a three-level generalized mixed model (adjusted OR 0.71, CI 0.58-0.85; P<0.001).

CONCLUSIONS: The use of surgical checklists varies across European nations. Reported use of a checklist was associated with lower mortality. This observation may represent a protective effect of the surgical checklist itself, or alternatively, may be an indirect indicator of the quality of perioperative care.

CLINICAL TRIAL REGISTRATION: The European Surgical Outcomes Study is registered with ClinicalTrials.gov, number NCT01203605.

JournalBritish Journal of Anaesthesia
Issue number5
Pages (from-to)801-807
Publication statusPublished - 2015

    Research areas

  • Checklist, Cohort Studies, Europe, Female, Hospital Mortality, Hospitals, Humans, Length of Stay, Male, Odds Ratio, Outcome Assessment (Health Care), Prevalence, Retrospective Studies, Risk Factors, Surgical Procedures, Operative, World Health Organization