title: Effect of Surgical Safety checklist implementation on the occurrence of postoperative complications in orthopedic patients.
abstract: BACKGROUND
  Surgical adverse events are errors that emerge during perioperative patient care. The World Health Organization recently published "Guidelines for Safe Surgery."
  
  
  OBJECTIVE
  To estimate the effect of implementation of a safety checklist in an orthopedic surgical department.
  
  
  METHODS
  We conducted a single-center cross-sectional study to compare the incidence of complications prior to and following implementation of the Guidelines for Safe Surgery checklist. The medical records of all consecutive adult patients admitted to the orthopedics department at Wolfson Medical Center during the period 1 July 2008 to 1 January 2009 (control group) and from 1 January 2009 to 1 July 2009 (study group) were reviewed. The occurrences of all complications were compared between the two groups.
  
  
  RESULTS
  The records of 760 patients (380 in each group) hospitalized during this 12 month period were analyzed. Postoperative fever occurred in 5.3% versus 10.6% of patients with and without the checklist respectively (P = 0.008). Significantly more patients received only postoperative prophylactic antibiotics rather than both pre-and postoperative antibiotic treatment prior to implementation of the checklist (3.2% versus 0%, P = 0.004). In addition, a statistically non-significant 34% decrease in the rate of surgical wound infection was also detected in the checklist group. In a logistic regression model of postoperative fever, the checklist emerged as a significant independent predictor of this outcome: odds ratio 0.53, 95% confidence interval 0.29-0.96, P = 0.037.
  
  
  CONCLUSIONS
  A significant reduction in postoperative fever after the implementation of the surgical safety checklist occurred. It is possible that the improved usage of preoperative prophylactic antibiotics may explain the reduction in postoperative fever.
authors.affiliation: Epidemiology Research Unit, Wolfson Medical Center, Holon, Israel.
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.affiliation: Department of Orthopedics, Wolfson Medical Center, Holon, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bermant
authors.affiliation: Department of Anesthesiology and Surgery, Wolfson Medical Center, Holon, Israel.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.affiliation: Department of Orthopedics, Wolfson Medical Center, Holon, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Lakstein
authors.affiliation: Directorate, Wolfson Medical Center, Holon, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Berlovitz
authors.affiliation: Department of Anesthesiology and Surgery, Wolfson Medical Center, Holon, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Laniado
authors.affiliation: Department of Orthopedics, Wolfson Medical Center, Holon, Israel.
authors.forename: Zeev
authors.initials: Z
authors.lastname: Feldbrin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D057189:Checklist; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D013530:Surgical Wound Infection / Q000517:prevention & control