WHO shows surgery best practices

There should be a strict implementation of WHO checklists while performing surgeries in India and other developing countries to reduce mortality risks, according to a recent study. The study was conducted by doctors of the gastro-intestinal department of Sir Ganga Ram Hospital.

It is estimated by experts that of more than 234 million surgical operations which are performed annually worldwide, at least half of the complications that occur are avoidable. According to the World Health Organisation (WHO), unsafe surgical care can cause substantial harm.

The randomised study was carried out with a sample size of 700 patients between February 2012 and April 2013. Most of the patients were in the high-risk groups with complex gastrointestinal procedures involved. The patients were divided into two groups, comprising 350 each.

The study shows that in the non-checklist group the mortality rate was 10 per cent while the mortality rate was 5.7 per cent in the checklist group. The rate of postoperative complications was also reduced in the second group.

The doctors implemented three sets of checklists – before the patient is administered anaesthesia, before an incision is made on the skin of the patient and before the patient leaves the operating room.

“The checklist was slightly modified from what the WHO recommends. With most of the patients in the high-risk category, the mortality rate was found to be lower in the checklist group. The post-operative complications were also found to be lower,” said Dr Samiran Nundy, author of the study and emeritus consultant, Department of Surgical Gastroenterology and Liver Transplant at the hospital.

The study, which doctors claim is the first randomised controlled study on this subject in a developing country, was published in the Journal of Gastrointestinal Surgery.

In a majority of cases, surgical complications are a major cause of mortality. Such complications also turn to be a major financial burden for the patient’s family members. However, implementation of checklist can significantly contribute to improving patients’ lives after operations are performed, according to doctors.

“Bleeding and wound-related complications decreased in the checklist group which could be due to better coordination between the teams involved in providing safety,” said Dr Neeraj Chaudhary, corresponding author of study and clinical assistant at the department.