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Perception of Safety of Surgical Practice Among Operating Room Personnel from Survey Data is Associated with All-Cause 30-Day Postoperative Death Rate in South Carolina
George Molina*1, William R Berry*1, Stuart R Lipsitz*1, Lizabeth Edmondson*1, Zhonghe Li1, Bridget A Neville*1, Aunyika T Moonan*2, Lorri R Gibbons*2, Atul A Gawande1, Sara J Singer*1, Alex B Haynes*1
1Ariadne Labs at Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA;2South Carolina Hospital Association, Columbia, SC

OBJECTIVE(S): To evaluate whether the perception of safety of surgical practice among operating room (OR) personnel is associated with hospital-level 30-day postoperative death.
METHODS: As part of the Safe Surgery 2015: South Carolina initiative, a baseline survey measuring the perception of safety of surgical practice among OR personnel was completed. We evaluated the relationship between hospital-level mean item survey scores and rates of all-cause 30-day postoperative death using binomial regression. Models were controlled for multiple patient, hospital, and procedure covariates using supervised principal components regression.
RESULTS: The overall survey response rate was 38.1% (1793/4707) among 31 hospitals. For every one point increase in the hospital-level mean score for respect (adjusted relative risk (aRR) 0.78, 95% CI 0.65-0.93, P=0.0059), clinical leadership (aRR 0.86, 95% CI 0.74-0.9932, P=0.0401), and assertiveness (aRR 0.71, 95% CI 0.54-0.93, P=0.01) among all survey respondents, there were associated decreases in the hospital-level 30-day postoperative death rate following inpatient surgery ranging from 14-29%. Higher hospital-level mean scores for the statement, “I would feel safe being treated here as a patient,” were associated with significantly lower hospital-level 30-day postoperative death rates (aRR 0.83, 95% CI 0.70-0.97, P=0.02). Although most findings seen among all OR personnel were seen among nurses, they were often absent among surgeons.
CONCLUSIONS: Perception of OR safety of surgical practice was associated with hospital-level 30-day postoperative deaths. Reducing postoperative deaths requires that surgeons lead in ways that result in a culture where OR personnel feel respected and invited to speak up on behalf of patient safety.

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