SYSTEMATIC REVIEW OF SURGICAL CHECKLIST IMPLEMENTATION AND ITS EFFECT ON MORTALITY AND MORBIDITY IN GENERAL SURGERY
Keywords:
General Surgery, Surgical Safety Checklist, Postoperative Complications, Mortality, Systematic Review, Patient SafetyAbstract
Background: The Surgical Safety Checklist (SSC) was widely implemented to enhance team communication and reduce preventable patient harm in the operating room. While initial studies were promising, the contemporary impact of the SSC on hard clinical endpoints in general surgery, amidst variable implementation fidelity and evolving surgical practices, requires an updated synthesis of the evidence.
Objective: This systematic review aimed to evaluate the impact of surgical safety checklist implementation on postoperative mortality and morbidity in patients undergoing general surgical procedures.
Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was performed for studies published between January 2019 and March 2024. Included studies were randomized controlled trials and cohort studies that compared SSC use to standard care and reported mortality or morbidity outcomes in general surgery populations. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 and Newcastle-Ottawa tools.
Results: Eight studies (n=85,600 patients) were included. The evidence demonstrated a consistent and significant association between SSC implementation and reduced postoperative mortality, a finding robust across multiple large-scale studies. The effect on overall morbidity and specific complications was positive but more heterogeneous, with high-quality evidence indicating that the degree of benefit is closely linked to the fidelity and compliance of checklist execution.
Conclusion: The implementation of a Surgical Safety Checklist is consistently associated with a significant reduction in mortality in general surgery, affirming its critical role in patient safety protocols. The full benefit on morbidity, however, appears contingent upon consistent and high-quality implementation, highlighting that the checklist's value is realized not merely by its presence but by the thoroughness of its use. Future efforts should focus on optimizing adherence and contextual integration to maximize its life-saving potential.
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Copyright (c) 2025 Bushra Jabeen, Uzma Zareef (Author)
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