We implemented the World Health Organization surgical safety checklist at Auckland City Hospital from November 2007. We hypothesised that the checklist would reduce postoperative mortality and increase days alive and out of hospital, both measured to 90 postoperative days. We compared outcomes for cohorts who had surgery during 18-month periods before vs. after checklist implementation. We also analysed outcomes during 9 years that included these periods (July 2004–December 2013). We analysed 9475 patients in the 18-month period before the checklist and 10,589 afterwards. We analysed 57,577 patients who had surgery from 2004 to 2013. Mean number of days alive and out of hospital (95%CI) in the cohort after checklist implementation was 1.0 (0.4–1.6) days longer than in the cohort preceding implementation, p < 0.001. Ninety-day mortality was 395/9475 (4%) and 362/10,589 (3%) in the cohorts before and after checklist implementation, multivariable odds ratio (95%CI) 0.93 (0.80–1.09), p = 0.4. The cohort changes in these outcomes were indistinguishable from longer-term trends in mortality and days alive and out of hospital observed during 9 years, as determined by Bayesian changepoint analysis. Postoperative mortality to 90 days was 228/5686 (4.0%) for Māori and 2047/51,921 (3.9%) for non-Māori, multivariable odds ratio (95%CI) 0.85 (0.73–0.99), p = 0.04. Māori spent on average (95%CI) 1.1 (0.5–1.7) fewer days alive and out of hospital than non-Māori, p < 0.001. In conclusion, our patients experienced improving postoperative outcomes from 2004 to 2013, including the periods before and after implementation of the surgical checklist. Māori patients had worse outcomes than non-Māori.

中文翻译：

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对术后存活天数和出院天数的回顾性审计，包括实施 WHO 手术安全检查表之前和之后

我们从 2007 年 11 月在奥克兰市医院实施了世界卫生组织的手术安全检查表。我们假设检查表会降低术后死亡率并增加存活天数和出院天数，均测量为术后 90 天。我们比较了在清单实施之前和之后的 18 个月期间接受过手术的队列的结果。我们还分析了包括这些时期（2004 年 7 月至 2013 年 12 月）在内的 9 年的结果。我们在检查表之前的 18 个月和之后的 10,589 个月内分析了 9475 名患者。我们分析了 2004 年至 2013 年接受手术的 57,577 名患者。实施清单后队列中的平均存活天数和出院天数 (95%CI) 比实施前的队列长 1.0 (0.4-1.6) 天，p < 0.001。清单实施前后队列的 90 天死亡率分别为 395/9475 (4%) 和 362/10,589 (3%)，多变量优势比 (95%CI) 0.93 (0.80–1.09)，p = 0.4。根据贝叶斯变点分析确定，这些结果的队列变化与 9 年内观察到的死亡率、存活天数和出院天数的长期趋势无法区分。毛利人术后 90 天的死亡率为 228/5686 (4.0%)，非毛利人为 2047/51,921 (3.9%)，多变量优势比 (95%CI) 0.85 (0.73–0.99)，p = 0.04。毛利人平均 (95%CI) 存活和出院的天数比非毛利人少 1.1 (0.5–1.7) 天，p < 0.001。总之，我们的患者在 2004 年至 2013 年期间经历了改善的术后结果，包括实施手术清单之前和之后的时期。