Tackling Current Issues in Global Health in the Clinical Setting

By Carla Todaro, MD, from the IARS, AUA and SOCCA 2019 Annual Meetings*

Davy Cheng, MD, MSc, FRCPS, FCAHS, CCPE; WFSA Chair, Scientific Affairs Committee, and IARS Trustee, led the session, WFSA and IARS Panel: Controversies in Global Health, addressing current issues facing global health in the clinical setting – establishing surgical safety checklists, perioperative FiO2 effects on postoperative morbidity and wound infection, and perspectives on task-sharing in anesthesia.

Janet Martin, MSc (HTA&M), PharmD, Western University and MEDICI Centre, began the session by focusing on surgical safety checklists and their impact on postoperative outcomes. The challenge is to determine whether the surgical safety checklist works. Atul Gawande, author of The Checklist Manifesto, tested the checklist with his research team who has applied the surgical safety checklist about the world with success.

According to Dr. Martin, a surgical safety checklist is designed to improve team communication as well as consistency of care, which reduces complications and deaths associated with surgery. She cited the article, “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population,” published in The New England Journal of Medicine.

The introduction of checklists has led to reduced infections of the surgical site and complications, Dr. Martin explained.

In in an article, “The World Health Organisation Surgical Safety Checklist Does Not Reduce Mortality in General Surgery,” published in the British Journal of Anaesthesia, Drs. Maria Vargas and Giuseppe Servillo, from the Department of Neuroscience and Reproductive and Odontostomatological Sciences, at the University of Naples Federico, ascertained that checklist compliance may affect the risks of mortality and postoperative complications. They determined that the WHO checklist compliance varied between studies.

Dr. Martin stated that the WHO checklist may improve postoperative outcomes, but more studies are needed in more varieties of surgical procedures to better understand the effectiveness.

She continued the discussion by analyzing situations where supplemental oxygen is required for patients, including anesthesia induction or in the prevention of death in the case of organ dysfunction.

In the article, “Supplemental Perioperative Oxygen to Reduce the Incidence of Surgical-Wound Infection,” published in The New England Journal of Medicine in 2000, Dr. Robert Greif and his colleagues from the Outcomes Research Group, in a collaborative study, demonstrated that the perioperative administration of supplemental oxygen was a method of reducing the incidence of surgical-wound infections. As further studies were conducted, the results outlined in Dr. Greif’s study have since been proved to not always be true, according to Dr. Martin.

Dr. Martin emphasized the importance of more focused research conducted for the right reason.

*Coverage from the WFSA and IARS Panel: Controversies in Global Health during the IARS 2019 Annual Meeting