Safe Surgery Saves LivesSafe Surgery Saves Lives

William R. Berry, MD, MPH, FACS

Cambridge, MA

August 2008

Bringing Surgery into the LightBringing Surgery into the Light

Unrecognized as public health issueMore surgeries are done each year than

there are births.Surgery is differentLack of data on surgery and outcomesFailure to use existing safety know how

 

Mean Estimated Surgical Rate (per 100,000 population)

Estimated volume of

surgery (% of total)

Percent of global

population

Poor Expenditure Countries(per capita total expenditure on health ≤$100 US) 326

7,258,507 (3.2%) 34.8%

Low Expenditure Countries(per capita total expenditure on health $101-400 US) 2,190

50,126,749 (21.8%) 35.0%

Middle Expenditure Countries(per capita total expenditure on health $401-1000 US) 4,169

34,636,447 (15.0%) 14.6%

High Expenditure Countries(per capita total expenditure on health >$1000 US) 11,129

138,090,970 (60.0%) 15.6%

Total Global Volume of Surgery   230,112,673  

Average Surgical Rate 3,987    

1999 Utah/Colorado study1999 Utah/Colorado study

Adverse Events3%

Uncomplicated97%

Nonoperative surgical 21%

Surgical 45%

Nonsurgical 33%

Review of charts from 15,000 admissions to 28 hospitals in 1992

Surgery 1999;126(1):66-75

Safer Surgery Saves LivesSafer Surgery Saves Lives

First Consultation Geneva Switzerland: 11-12 January 2007 Over 50 participants from around the globe Reviewed possible work in four areas:

– Clean Surgery• The surgical environment

– Safe Anesthesia– The surgical provider

• The safe surgical team

– Measuring the safety of surgery • A Surgical “Vital Sign”

How the Pilot's Checklist Came About

The Surgical ChecklistThe Surgical Checklist

SimpleUniversalEasily understoodSaving lives and decreasing

complications

Site Cases Use of Pulse

Oximeter

Time Out to Confirm Site/Pt

Abx @ 0-60 mins

IV Access

>500 cc EBL

1 377 100% 100% 98% 93%

2 317 97% 8.8% 52% 73%

3 232 96% 100% 34% 7%

4 481 77% 22% 25% 49%

5 338 97% 50% 75% 80%

6 524 99% 99% 48% 32%

7 519 100% 99% 78% 67%

8 446 99% 17% 18% 73%

Preliminary Pilot Site Results

Total Cases 3234

Site Infection Complication Death

1 1.1% 7.2% 0.4%

2 1.3% 5.3% 0%

3 23.8% 24.2% 1.7%

4 3.7% 9.8% 3.5%

5 6.5% 14% 0%

6 9.4% 12% 2.1%

7 3.1% 6.4% 1.0%

8 4.0% 6.3% 1.3%

Preliminary Pilot Site Results

Total Cases 3234

http://www.who.int/patientsafety/safesurgery/en/index.html