The Role of WHO Surgical Checklists in Reducing Postoperative Adverse Outcomes: A Systematic Review

Surgical safety remains a critical aspect of modern healthcare, particularly as the number of surgical procedures continues to rise, placing greater demands on resources and increasing the potential for errors. In response to this challenge, various mitigation strategies have been implemented to improve operative outcomes. One such strategy, introduced by the WHO in 2008, is the Surgical Safety Checklist. Despite its widespread adoption globally, its acceptance remains limited in developing countries. This systematic review aimed to evaluate the impact of the WHO Surgical Safety Checklist, specifically the sign-in, time-out, and sign-out components, on reducing post-operative adverse effects in surgical patients. A single-step search strategy was employed across multiple databases, including Medline, CINAHL, Embase, Cochrane Database, ProQuest, Index Copernicus, Google Scholar, and Scopus. Additionally, reference lists of identified reports and articles were manually searched to identify further relevant studies. Only studies published in English before September 2022 that focused exclusively on the WHO Surgical Safety Checklist were included. Studies on other checklists or those with confounding factors, such as international surgical outcomes studies, were excluded from this analysis. After screening 17,821 publications based on their titles and abstracts, 93 studies met the initial inclusion criteria and underwent full retrieval and assessment for methodological quality. Ultimately, 13 studies were deemed of sufficient quality to be included in the review. Among these, 10 studies reported outcomes related to complication rates, with nine of them demonstrating a decrease in complication rates following checklist implementation. Similarly, 13 studies reported outcomes related to mortality rates, with 12 reporting a decrease in mortality rates associated with checklist use. In conclusion, the application of the WHO Surgical Safety Checklist has been shown to improve surgical outcomes by reducing post-operative adverse effects, including mortality and complication rates. However, further research is warranted to assess the checklist's impact on the quality of life of surgical patients, which would contribute to enhancing its overall acceptability. Continued investigation into these areas will help further strengthen the evidence supporting the widespread adoption and effective implementation of the WHO Surgical Safety Checklist across diverse healthcare settings globally.