Article Text

Download PDFPDF

Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China
  1. Xiaochu Yu1,
  2. Jingmei Jiang2,
  3. Hong Shang3,
  4. Shizheng Wu4,
  5. Hong Sun5,
  6. Hanzhong Li1,
  7. Shijie Xin3,
  8. Shengxiu Zhao4,
  9. Yuguang Huang1,
  10. Xinjuan Wu1,
  11. Xu Zhang3,
  12. Yaolei Wang5,
  13. Fang Xue2,
  14. Wei Han2,
  15. Zixing Wang2,
  16. Yaoda Hu2,
  17. Lei Wang2,
  18. Yupei Zhao1
  1. 1 Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
  2. 2 Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
  3. 3 The First Hospital of China Medical University, Shenyang, China
  4. 4 Qinghai Provincial People’s Hospital, Xining, China
  5. 5 Xiangya Hospital, Central South University, Changsha, China
  1. Correspondence to Dr Xiaochu Yu; yuxch{at} and Dr. Yupei Zhao; zhao8028{at}


Objectives To develop a risk-stratified intervention strategy and evaluate its effect on reducing surgical complications.

Design A multicentre prospective study with preintervention and postintervention stages: period I (January to June 2015) to develop the intervention strategy and period II (January to June 2016) to evaluate its effectiveness.

Setting Four academic/teaching hospitals representing major Chinese administrative and economic regions.

Participants All surgical (elective and emergent) inpatients aged ≥14 years with a minimum hospital stay of 24 hours, who underwent a surgical procedure requiring an anesthesiologist.

Interventions Targeted complications were grouped into three categories (common, specific, serious) according to their incidence pattern, severity and preventability. The corresponding expert consensus-generated interventions, which focused on both regulating medical practices and managing inherent patient-related risks, were implemented in a patient-tailored way via an electronic checklist system.

Primary and secondary outcomes Primary outcomes were (1) in-hospital death/confirmed death within 30 days after discharge and (2) complications during hospitalisation. Secondary outcome was length of stay (LOS).

Results We included 51 030 patients in this analysis (eligibility rate 87.7%): 23 413 during period I, 27 617 during period II. Patients’ characteristics were comparable during the two periods. After adjustment, the mean number of overall complications per 100 patients decreased from 8.84 to 7.56 (relative change 14.5%; P<0.0001). Specifically, complication rates decreased from 3.96 to 3.65 (7.8%) for common complications (P=0.0677), from 0.50 to 0.36 (28.0%) for specific complications (P=0.0153) and from 3.64 to 2.88 (20.9%) for serious complications (P<0.0001). From period I to period II, there was a decreasing trend for mortality (from 0.64 to 0.53; P=0.1031) and median LOS (by 1 day; P=0.8293), without statistical significance.

Conclusions Implementing a risk-stratified intervention strategy may be a target-sensitive, convenient means to improve surgical outcomes.

  • risk-stratified intervention
  • perioperative checklist
  • surgical patient safety
  • surgical complication

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • XY and JJ contributed equally.

  • Contributors XY is the project’s principal investigator. XY and JJ take responsibility for the integrity of the data and the accuracy of the data analysis. XY, JJ, XW and YZ contributed to the conception and design of the study. HL, YH, XW and SZ contributed substantially to the acquisition of data. XY, JJ, YZ, HL, YH, HS, SX, HSun, SW, ZW, WH, FX, YHu and LW were responsible for statistical analysis or interpretation of data. XY and JJ took part in the draft writing of the manuscript. YZ, YW, HL, YH, HS, SX, XZ, HSun, SW and SZ provided administrative, technical or material support. XY, HS, XZ, HSun and SW contributed to the study supervision.

  • Funding This study was supported by the National Health and Family Planning Commission of China (grant number 201402017).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.