safe surgery saves lives william r. berry, md, mph, facs cambridge, ma august 2008
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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
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