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Effectiveness of the Surgical Safety Checklist in a High Standard Care Environment

Lübbeke, Anne MD, DSc*; Hovaguimian, Frederique MD; Wickboldt, Nadine MD; Barea, Christophe PhD*; Clergue, François MD; Hoffmeyer, Pierre MD*; Walder, Bernhard MD

doi: 10.1097/MLR.0b013e31828d1489
Brief Report

Background: Use of surgical safety checklists has been associated with significant reduction in postoperative surgical site infection (SSI), morbidity, and mortality.

Objective: To evaluate the effectiveness of an intraoperative checklist in high-risk surgical patients in a high standard care environment with long-standing regular perioperative safety control programs.

Research Design: Quasi-experiment pre-post checklist implementation.

Subjects: Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3–5 operated upon at a large tertiary hospital.

Measures: Unplanned return to operating room for any reason, reoperation for SSI, unplanned admission to intensive care unit, and in-hospital death within 30 days.

Results: A total of 609 patients (53% elective, 85% ASA 3, mean age 70 y) were included before and 1818 after implementation (52% elective, 87% ASA 3, mean age 69 y), the latter with 552, 558, and 708 in period I, II, and III, respectively. Comparing preimplementation to postimplementation periods: unplanned return to operating room occurred in 45/609 (7.4%) versus 109/1818 (6.0%) interventions [adjusted risk ratios (RR) 0.82; 95% confidence interval (CI), 0.59–1.14]; reoperation for SSI in 18/609 (3.0%) versus 109/1818 (1.7%) interventions (adjusted RR 0.56; 95% CI, 0.32–1.00); unplanned admission to intensive care unit in 17 (2.8%) versus 48 (2.6%) interventions (adjusted RR 0.90; 95% CI, 0.52–1.55); and in-hospital death occurred in 26 (4.3%) versus 108 (5.9%) patients (adjusted RR 1.44; 95% CI, 0.97–2.14). Checklist use during 77 interventions prevented 1 reoperation for SSI.

Conclusions: A trend toward reduced reoperation rates for SSI was observed after checklist implementation in this high standard care environment; no influence on other outcome measures was observed.

*Division of Orthopaedics and Trauma Surgery

Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland

The authors declare no conflict of interest.

Reprints: Anne Lübbeke, MD, DSc, Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. E-mail: anne.lubbekewolff@hcuge.ch.

© 2013 Lippincott Williams & Wilkins, Inc.