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Supplemental material, sj-pdf-1-aic-10.1177_0310057X221092455 for Perioperative provider safety in the pandemic: Development, implementation and evaluation of an adjunct COVID-19 Surgical Patient Checklist by Nichole E Starr Conceptualization Formal analysis Investigation Methodology Project administration Validation Writing – original draft Writing – review & editing Jolene N Moore Conceptualization Formal analysis Investigation Methodology Writing – review & editing Constance S Harrell Shreckengost Investigation Validation Writing – review & editing Katie Fernandez Formal analysis Investigation Project administration Writing – review & editing Reshma P Ambulkar Investigation Writing – review & editing Nina Capo-Chichi Conceptualization Investigation Methodology Validation Writing – review & editing John E Varallo Formal analysis Writing – review & editing Adesoji O Ademuyiwa Conceptualization Methodology Writing – review & editing Sophallyda Krouch Conceptualization Investigation Validation Writing – review & editing Pankaj Singh Rana Writing – review & editing JC Allen Ingabire Investigation Writing – review & editing Thomas G Weiser Conceptualization Formal analysis Investigation Methodology Writing – review & editing Tihitena Negussie Mammo Investigation Methodology Writing – review & editing Faye M Evans Conceptualization Formal analysis Investigation Methodology Writing – review & editing in Anaesthesia and Intensive Care

Additional file 1.

Data from household surveys serve as the backbone to sustainable development planning. For the first time, questions on surgery have been included in a nationwide Demographic and Health Survey, showing that it is feasible to integrate these questions into a large-scale survey., Key Findings Based on this pilot survey, which responded to the call to collect, aggregate, and analyze global anesthesia and surgery data, we conclude that it is feasible to integrate surgical questions into a large-scale sample survey to provide insight into surgical needs at a national level.Approximately 5% of women and 2% of men had undergone an operation in Zambia in the past 5 years. Among women, cesarean delivery was the most common surgery, while circumcision was the most common procedure among men.The diagnosed unmet need for surgical care in Zambia is estimated to be 65%. Key Implications For health system strengthening, baseline data and monitoring of progress are necessary. Improved data capabilities allow for mapping out and understanding systems.Data collection mechanisms pertinent to surgical care need to become part of routine data collection processes.There is a need to build on existing data collection mechanisms to avoid adding unnecessary burden, information overload, and data collection fatigue.The replicable design of the Demographic and Health Survey allows for the systematic collection of comparable surgical data in other settings. Similar questions could be included in other surveys as well.There is a need to establish data pathways to ensure clear responsibilities among national and international institutions and integrate surgical metrics into existing mechanisms for sustainable data collection., Background: While primary data on the unmet need for surgery in low- and middle-income countries is lacking, household surveys could provide an entry point to collect such data. We describe the first development and inclusion of questions on surgery in a nationally representative Demographic and Health Survey (DHS) in Zambia. Method: Questions regarding surgical conditions were developed through an iterative consultative process and integrated into the rollout of the DHS survey in Zambia in 2018 and administered to a nationwide sample survey of eligible women aged 15–49 years and men aged 15–59 years. Results: In total, 7 questions covering 4 themes of service delivery, diagnosed burden of surgical disease, access to care, and quality of care were added. The questions were administered across 12,831 households (13,683 women aged 15–49 years and 12,132 men aged 15–59 years). Results showed that approximately 5% of women and 2% of men had undergone an operation in the past 5 years. Among women, cesarean delivery was the most common surgery; circumcision was the most common procedure among men. In the past 5 years, an estimated 0.61% of the population had been told by a health care worker that they might need surgery, and of this group, 35% had undergone the relevant procedure. Conclusion: For the first time, questions on surgery have been included in a nationwide DHS. We have shown that it is feasible to integrate these questions into a large-scale survey to provide insight into surgical needs at a national level. Based on the DHS design and implementation mechanisms, a country interested in including a set of questions like the one included in Zambia, could replicate this data collection in other settings, which provides an opportunity for systematic collection of comparable surgical data, a vital role in surgical health care system strengthening.

Clean Cut Qualitative Interview Guide. (DOCX 28 kb)

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high‐HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P < 0·001), but the relationship was reversed in low‐HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30‐day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low‐ and middle‐HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low‐HDI countries was half that in high‐HDI countries.

The target rate for trauma undertriage is 70% for both). In conclusion, in contrast to our hypothesis, we found that triage is largely determined by mechanism of injury regardless of injury severity. High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance.