Institutional members access full text with Ovid®

Share this article on:

Effect of Surgical Safety Checklists on Postoperative Morbidity and Mortality Rates, Shiraz, Faghihy Hospital, a 1-Year Study

Askarian, Mehrdad MD, MPH; Kouchak, Farideh MD; Palenik, Charles John PhD, DDS, MS, MBA

doi: 10.1097/QMH.0b013e318231357c
Original Articles

Objective: The study intent was to (1) encourage the use of surgical safety checklists and (2) measure the effect checklists have in reducing surgical complications.

Design: An interventional study designed to improve postsurgical outcomes was performed.

Setting: The study site was a 374-bed referral educational hospital in Shiraz, Iran, with 6 operating rooms. The study lasted 6 months.

Participants: Patient selection involved a convenient sampling method with all eligible patients entering.

Intervention: Our checklist covered 3 surgical stages-–before anesthesia, immediately before an incision, and before moving the patient to a recovery room. Persons included were operating room team members.

Main outcome measures: Rates of postsurgical complication before and after application of the surgical safety checklist underwent comparison.

Results: Incidence of any complication before and after intervention was 22.9% and 10% (P = .03). Five checklist items were in total compliance. The most common complication was surgical site infection. Implementation of the checklist, responsibility in 2 stages, such as time out and sign out, were significant (P < .05). In most cases, these items reflected the performance of surgeons and anesthesia professionals as compared with the World Health Organization Surgical Safety Checklist.

Conclusion: Complications decreased by 57% after intervention. Both high patient information detection and elevated levels of cooperation by surgical personnel were observed. Compliance likely helped prevent some adverse effects associated with surgery.

Department of Community Medicine, Medicinal & Natural Products Chemistry Research Center (Dr Askarian) and Resident of Community Medicine (Dr Kouchak), Shiraz University of Medical Sciences, Iran; and Department of Oral Biology, Infection Control Research & Services, Indian University School of Dentistry, Indianapolis (Dr Palenik).

Correspondence: Mehrdad Askarian, MD, MPH, Department of Community Medicine, Shiraz University of Medical Sciences, PO Box 71345-1737, Shiraz, Iran (

The authors thank all health care workers of Faghihi Hospital and managers who helped them to do this project.

Funded by Vice Chancellor of Research, Shiraz University of Medical Sciences.

The authors declare no conflict of interest.

©2011Lippincott Williams & Wilkins, Inc.