Uso do checklist de cirurgia segura da Organização Mundial da Saúde como estratégia de redução de complicações e mortalidade em cirurgias colorretais: uma análise de duas realidades, Brasil X Canadá

• Ano de defesa: 2019
• Autor(a) principal: Camila Sarmento Gama
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; ENF - DEPARTAMENTO DE ENFERMAGEM BÁSICA; Programa de Pós-Graduação em Enfermagem; UFMG
• Palavras-chave em Português: Segurança do paciente; Procedimentos cirúrgicos operatórios; Lista de checagem; Organização Mundial da Saúde; Enfermagem; Infecção da ferida cirúrgica
• Link de acesso: http://hdl.handle.net/1843/30365

Introduction: Adverse events are responsible for a huge number of complications, disability, and death in surgical patients. It is estimated that, annually, happens seven million complications and that around one million dies during or immediately after surgery. In this sense, in order to minimize its occurrence, in 2008, the World Health Organization (WHO) launched a global challenge “Safe Surgery Saves Lives”, aiming to improve quality of care given to these patients. The challenge proposed an application of a surgical checklist that contributes to awakening the multiprofessional team to simple actions, but essentials considering the complexity of the surgical procedure. Considering the proposal of checklist implementation in patient safety improvement, this study had the following guiding questions: What is the impact of adoption of surgical checklist on Surgical Site Infection (SSI), readmission, reoperation, and mortality in 30 days follow up in two facilities from different settings: Brazil and Canada? Aim: To analyze the impact of adoption of surgical safety checklist on the occurrence of SSI, readmission, reoperation, and mortality in colorectal surgeries of two institutions of different settings: Brazil and Canada. Methods: A retrospective study was conducted in one hospital in Belo Horizonte, Minas Gerais, Brazil and one hospital in Ottawa, Ontario, Canada, both large, public, and university hospitals. This study respected 466 Resolution 2012 of Brazilian National Health Council and it was part of a broader project, which was approved by the Brazilian Research Ethics Board (037048/2017) and Canadian Research Ethics Board (#20170449-01H). Data collection was done through chart review where checklist completion and complications as an unplanned return to the operating room, readmission, SSI and mortality up to thirtieth day in postoperative colorectal procedures were analyzed, from January 2015 to July 2017 in both institutions. To evaluate the impact of surgical checklist implementation also was analyzed the same data from patients in the year before checklists implementation, being these matched by sex, age, ASA (American Society of Anesthesiologists) score, wound classification, type of surgery (elective or urgency), and duration of operation. The results were evaluated by institution and compared between them. Data was statistically analyzed in the Statistical Package for the Social Sciences (SPSS) for Windows (version 21.0) where it was carried out measures of central tendency and dispersion; inferential analysis, nonparametric test, chi-square or Fisher exact test, for categorical variables, simple t Student or Mann-Whitney test, for continuous variables. Results: A total of 518 medical records were included in Brazil, of which 171 (33%) were in the period before the implementation of the surgical checklist and 347 (67%) after the implementation of the checklist; and 842 medical records in Canada, of which 177 (21%) corresponded to the period before the implementation of the surgical checklist and 665 (79%) after the implementation of the checklist. Regarding the completion of the checklist in Brazil, 222 (64%) were complete and 125 (36%) were incomplete. In Canada, of the 665 records evaluated with the presence of the checklist, it was observed that 657 (98.8%) were complete and 8 (1.2%) were incomplete. Regarding the outcomes, in Brazilian hospital the SSI rate decreased after the implementation of the checklist from 17% to 14.4%, and readmission also fell from 2.9% to 1.7%, the number of reoperations increased from 5.3 % to 8.1%, and deaths from 1.8% to 3.5%. In Canadian hospital the SSI rate reduced after the implementation of the checklist from 27.7% to 25.9%, readmission increased from 6.8% to 8.1%, reoperation decreased from 5.6% to 4.8%, and deaths from 1.7% to 0.9%. But in no setting the outcomes were statistically significant. It was observed a direct association between a high number of incomplete checklists and development of SSI in Brazil (p = 0.026). Conclusion: The present study verified that although the checklist has been adopted with adaptations in different scenarios, its implementation was not able to reduce surgical complications and mortality in colorectal surgeries in the distinct settings studied, as evidenced by the WHO. However, the significant association between the increase in incomplete checklists and the development of SSI in Brazil and the absence of such relationship in Canada suggests that the impact of the checklist may be greater in developing countries, where patient safety policies are fragile and multimodal strategies for SSI control and prevention are scarce, diverging from the reality of developed countries. However, it is still questionable whether the potential impact of this tool on these scenarios would be permanent or punctual, since the checklist only, without the aid of other measures, may not have a sustained long-term effect.