title: Effectiveness of the surgical safety checklist in a high standard care environment.
abstract: 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.
  
  
  METHODS
  Quasi-experiment pre-post checklist implementation.
  
  
  METHODS
  Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3-5 operated upon at a large tertiary hospital.
  
  
  METHODS
  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.
authors.affiliation: Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland. anne.lubbekewolff@hcuge.ch
authors.forename: Anne
authors.initials: A
authors.lastname: Lübbeke
authors.forename: Frederique
authors.initials: F
authors.lastname: Hovaguimian
authors.forename: Nadine
authors.initials: N
authors.lastname: Wickboldt
authors.forename: Christophe
authors.initials: C
authors.lastname: Barea
authors.forename: François
authors.initials: F
authors.lastname: Clergue
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Walder
mesh_terms: D000368:Aged; D057189:Checklist; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D057216:Propensity Score; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery