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A Health Economic Evaluation of the World Health Organization Surgical Safety Checklist: A Single Center Assessment

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Andy Healey, Eirik Søfteland, Stig Harthug, Rune Haaverstad, Rupavathana Mahesparan, Bjørg Merete Hjallen, Geir Egil Eide, Nick Sevdalis, Arvid Steinar Haugen

Original languageEnglish
Pages (from-to)679-684
Number of pages6
JournalAnnals of Surgery
Issue number4
Published1 Apr 2022

Bibliographical note

Funding Information: This study received departmental support from Departments at Haukeland University Hospital, Bergen, Norway. ASH receive postdoctoral grant from the Western Norwegian Regional Health Authority with grant number (ref: HV1172). AH and NS are supported by the National Institute for Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa at King's College London (GHRU 16/136/54) and by the NIHR Applied Research Collaboration: South London at King's College Hospital NHS Foundation Trust. NS and AH are also members of King's Improvement Science, which offers co-funding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas’ NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas’ Charity and the Maudsley Charity. NS is further supported by the ASPIRES research program in LMICs (Antibiotic use across Surgical Pathways - Investigating, Redesigning and Evaluating Systems), funded by the Economic and Social Research Council (ESRC). The views expressed in this publication are those of the author(s) and not necessarily those of IFNA, ESA, the NHS, the NIHR, the ESRC or the Department of Health and Social Care or the study's host organization. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

King's Authors


OBJECTIVES: To evaluate cost-effectiveness of the WHO Surgical Safety Checklist. BACKGROUND: The clinical effectiveness of surgical checklists is largely understood. Few studies to-date have evaluated the cost-effectiveness of checklist use. METHODS: An economic evaluation was carried out using data from the only available randomized controlled trial of the checklist. Analyses were based on 3702 procedures. Costs considered included checklist implementation costs and length and cost of hospital stay, costs of warming blanket use, blood transfusions and antibiotics used in the operating room, and the cost of clinical time in the operating room - all calculated for each procedure and its associated admission. Nonparametric bootstrapping was used to simulate an empirical distribution of the mean effect of the checklist on total admission costs and the probability of observing a complication-free admission and to quantify sampling uncertainty around mean cost estimates. RESULTS: The overall cost of checklist implementation was calculated to be $900 per 100 admissions. Implementation of the WHO checklist resulted in an additional 5.9 complication-free admissions per 100 admissions and an average of 110 bed-days saved per 100 admissions. Accounting for all costs included in the analysis, for every 100 admissions, use of the WHO checklist was estimated to save $55,899. CONCLUSIONS: Implementation of the WHO checklist was a cost-effective strategy for improving surgical safety.

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