Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations.
OBJECTIVE
Use of the WHO surgical checklist has been proven to reduce surgical morbidity and mortality, but its effect on surgical complications requiring reoperation has not been previously studied. The aim of this study was to determine whether the use of the WHO surgical checklist would have an impact on the number and causes of neurosurgical complications leading to a reoperation.


METHODS
The authors retrospectively gathered information on all neurosurgical reoperations using hospital discharge data as well as the operations and procedures registry, and tracked all primary neurosurgical operations (n = 175) preceding a complication-related reoperation from 2007 to 2011. There were a total of 5418 neurosurgical operations during the study period. For further analysis of electronic patient records, the primary operations were divided into 2 groups based on the time of the WHO surgical checklist implementation in the authors' unit: 103 operations before and 72 after the introduction of the checklist. Observed adverse events and reoperations were categorized as preventable or unpreventable, and the actual use of the checklist during each operation was recorded.


RESULTS
The overall rate of preventable complication-related neurosurgical reoperations decreased from 3.3% (95% CI 2.7%-4.0%) to 2.0% (95% CI 1.5%-2.6%) after the checklist implementation. The reoperations were mainly due to wound infections, 46% before and 39% after the checklist. All infection-related reoperations proportioned to all neurosurgical operations (2.5% before vs 1.6% after checklist implementation) showed a significant reduction (p = 0.02) after the implementation of the checklist. In particular, there was a significant decrease (p = 0.006) in the rate of preventable infections associated with reoperations, i.e., 2.2% before versus 1.2% after checklist implementation. The overall adherence to checklist use (the "time out" phase) in neurosurgical operations was 78%, and adherence was 70% in primary operations preceding a complication-related reoperation regarded as preventable.


CONCLUSIONS
The implementation of the WHO surgical checklist in neurosurgery was associated with a decrease in complication-related reoperations, especially those due to preventable infection complications, the majority of which were wound infections. The adherence to checklist use in individual operations after the checklist implementation did not appear to have an impact on the results.
Faculty of Medicine, University of Turku;
Marjut
M
Lepänluoma
Division of Clinical Neurosciences, Department of Neurosurgery, and.
Melissa
M
Rahi
Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku;
Riikka
R
Takala
Department of Biostatistics, University of Turku; and.
Eliisa
E
Löyttyniemi
Administrative Centre, Hospital District of Southwest Finland, Turku, Finland.
Tuija S
TS
Ikonen
D000328:Adult; D000368:Aged; D057189:Checklist / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D011183:Postoperative Complications / Q000517:prevention & control*; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014944:World Health Organization
CI = confidence interval; WHO; adverse event; infection; reoperation; surgical safety checklist