Safe surgery
Why safe surgery is important
Surgical care has been an essential component of health care worldwide for over a century. As the incidences of traumatic injuries, cancers and cardiovascular disease continue to rise, the impact of surgical intervention on public health systems will continue to grow.
Surgery is often the only therapy that can alleviate disabilities and reduce the risk of death from common conditions. Every year, many millions of people undergo surgical treatment, and surgical interventions account for an estimated 13% of the world’s
total disability-adjusted life years (DALYs).
While surgical procedures are intended to save lives, unsafe surgical care can cause substantial harm. Given the ubiquity of surgery, this has significant implications:
- the reported crude mortality rate after major surgery is 0.5-5%;
- complications after inpatient operations occur in up to 25% of patients;
- in industralized countries, nearly half of all adverse events in hospitalized patients are related to surgical care;
- at least half of the cases in which surgery led to harm are considered preventable;
- mortality from general anaesthesia alone is reported to be as high as one in 150 in some parts of sub-Saharan Africa.
WHO and surgical safety
WHO has undertaken a number of global and regional initiatives to address surgical safety. Much of this work has stemmed from the WHO Second Global Patient Safety Challenge “Safe Surgery Saves Lives”. Safe Surgery Saves Lives set about to
improve the safety of surgical care around the world by defining a core set of safety standards that could be applied in all WHO Member States.
To this end, working groups of international experts were convened to review the literature and
the experiences of clinicians around the world. They reached consensus on four areas in which dramatic improvements could be made in the safety of surgical care: surgical site infection prevention, safe anaesthesia, safe surgical teams and measurement
of surgical services.
Member States have continued to be active in addressing these issues. Much of this work has been initiated by the global implementation of the WHO Surgical Safety Checklist, a 19-item tool created by WHO in association with the Harvard School of Public Health.
Learn more about the WHO Surgical Safety Checklist and download associated resources
Publications
Other projects
Pulse oximetry
Pulse oximeters are medical devices that monitor the level of oxygen in a patient's blood and alert the health-care worker if oxygen levels drop below safe levels, allowing rapid intervention. These devices are essential in any setting in which a patient's blood oxygen levels requires monitoring like operations, emergency and intensive care, and treatment and recovery in hospital wards.
WHO Patient Safety Pulse Oximetry Project
The goal of the Patient Safety Pulse Oximetry project is to improve the safety of anaesthesia care in operating rooms in low and middle-income countries, by testing the effect on patient outcome of providing a bundle consisting of the Surgical Safety Checklist, pulse oximeters and training in a number of pilot hospitals globally.
Why pulse oximetry?
The Patient Safety Pulse Oximetry project aims to improve the safety of operating rooms worldwide. The Surgical Safety Checklist has been shown to reduce complications and mortality by over 30 percent. The Checklist is simple and can be completed in under 2 minutes, however, there is one component that is not currently achievable in every operating room in the world: pulse oximetry. WHO Patient Safety has worked with the Harvard School of Public Health, the WFSA, the AAGBI and many other partners around the world to facilitate the development of pulse oximetry technical standards that led to the development of a high standard, low-cost pulse oximeter.
Pulse oximetry: training material
A large number of anaesthesia providers in low resource settings lack sufficient training about monitoring oxygen levels in the blood. WHO Patient Safety, together with the World Federation of Societies of Anaesthesiologists (WFSA), the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and others, has developed a training tool kit, consisting of a manual, a video and slide sets to improve provider response to hypoxemia. The training material can be downloaded from the following page:
- Pulse Oximetry Training Manual
The Training Manual will help you understand the physiology of oxygen transport, how low oxygenation occurs and how to use pulse oximetry to improve the safety of patients during anaesthesia. Questions on each learning objective help you to assess your knowledge and understanding.
Download: English
- Hypoxia Management Plan
The Hypoxia Management Plan summarizes the interventions needed to intervene in case of low oxygenation.
Download: Low resolution | High resolution
- Tutorial 1 - Basic
These tutorials are a step-by-step teaching and learning guide using the same modules outlined in the Training Manual.
Download: English
- Tutorial 2 – Advanced
Download: English
SAFROS Project: patient safety in robotic surgery
The SAFROS Project was funded by the European Commission and aims to understand patient safety in robotic surgery through the development of technologies and procedures to assist surgeons. The main goal of the SAFROS project was to explore whether robotic surgery carried out in accordance with safety criteria can improve the level of patient safety currently achievable by traditional surgery. The project endeavoured to:
- analyze safety in robotic surgery;
- formalize safety requirements;
- establish safety procedures;
- establish verification protocols.
These were tested in pancreatic and vascular surgery.
The project was developed by several partners composing the SAFROS consortium: hospitals with worldwide reputations to provide medical knowledge and to validate the approach; leading European research groups in tele-robotics and surgical robotics; innovative companies to develop new technologies for surgical simulators; renowned educational organizations to provide innovative surgeon training; and WHO Patient Safety to offer global expertise in safety guidelines for patient surgery. By participating in this project and using robotic surgery as an example, WHO Patient Safety wanted to better understand how to ensure the inclusion of patient safety in the development of new technologies and devise appropriate methodologies for doing so.