手術檢查表可以改善心臟以外手術的結果


  January 14, 2009 — 根據1月14日線上登載、即將於1月29日付印的新英格蘭醫學期刊中的一年縱向研究結果,對於16歲以上、在各種醫院接受心臟以外手術的病患,完成手術檢查表與降低死亡率及較少併發症有關。
  
  安全手術救命研究小組的Alex B. Haynes醫師等人寫道,手術是整體健康照護中不可或缺的一部份,估計每年有23,400萬件手術,我們設定一個計畫,完成19項手術安全檢查表來改善團隊溝通與照護的一致性,以期減少手術相關併發症與死亡。
  
  研究目標是評估於住院手術中完成此檢核表對嚴重併發症和死亡率的影響,參加研究的八個醫院代表世界衛生組織內各個不同社會經濟環境的區域,分別位於約旦安曼;印度新德里;華盛頓州西雅圖;坦尚尼亞伊法卡拉; 菲律賓馬尼拉; 加拿大多倫多; 英國倫敦; 以及紐西蘭奧克蘭。
  
  總共有3,733名16歲以上的心臟以外手術病患,以前溯方式收集有關臨床病程與結果的資料,完成這個「手術安全檢查清單」之後,總共獲得3,955名非心臟手術病患的資料,初級終點是死亡率以及術後30天內住院病患的其他併發症。
  
  住院期間死亡率從一開始的1.5%降低到使用檢查清單後的0.8%(P = .003),住院病患併發症比率也降低,從11.0%降低到7.0% (P < .001)。研究作者寫道,完成檢查清單與減少各醫院接受心臟以外手術之病患死亡率及較少併發症有關。
  
  研究限制包括,可能有霍桑效應(Hawthorne effect),比較的是介入前和介入後的資料,資料僅限於住院病患併發症,可能不具其他醫院的一般性。
  
  研究作者結論表示,運用到全球後,這個檢查清單有潛力預防更多死亡與失能併發症,但需要後續研究,以確認明確的機轉,以及具體設定的持久性。
  
  世界衛生組織支持本研究。研究作者宣稱沒有相關財務關係。

Surgical Checklist May Improve Outcomes for Noncardiac Surgery

By Laurie Barclay, MD
Medscape Medical News

January 14, 2009 — Implementation of a surgical checklist is associated with lower death rates and fewer complications in patients aged at least 16 years who are undergoing noncardiac surgery in a diverse group of hospitals, according to the results of a 1-year longitudinal study published online January 14 and will appear in the January 29 print issue of the New England Journal of Medicine.

"Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly," write Alex B. Haynes, MD, MPH, and colleagues from the Safe Surgery Saves Lives Study Group. "We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery."

The objective of the study was to evaluate the effect on rates of mortality and major complications of implementing this checklist in inpatient surgical units. The 8 participating hospitals represented a diverse group of socioeconomic environments within World Health Organization regions and were located in Amman, Jordan; New Delhi, India; Seattle, Washington; Ifakara, Tanzania; Manila, Philippines; Toronto, Canada; London, United Kingdom; and Auckland, New Zealand.

For 3733 consecutive inpatient noncardiac surgery patients 16 years or older, data were prospectively collected regarding clinical processes and outcomes. After implementation of the Surgical Safety Checklist, data were collected from 3955 consecutive inpatient noncardiac surgery patients. The primary endpoint was the rate of death and other complications in hospitalized patients during the first 30 days after surgery.

Death rate during hospitalization decreased from 1.5% in the initial cohort to 0.8% after implementation of the checklist (P = .003). The corresponding decline in the rate of any inpatient complication was from 11.0% to 7.0% (P < .001).

"Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals," the study authors write.

Limitations of this study include possible Hawthorne effect, comparison of preintervention with postintervention data, data collection restricted to inpatient complications, and possible lack of generalizability to other hospitals.

"Applied on a global basis, this checklist program has the potential to prevent large numbers of deaths and disabling complications, although further study is needed to determine the precise mechanism and durability of the effect in specific settings," the study authors conclude.

The World Health Organization supported this study. The study authors have disclosed no relevant financial relationships.

N Engl J Med. 2009;360:491-499.

    



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