title: Effect of surgical safety checklists on pediatric surgical complications in Ontario.
abstract: BACKGROUND
  In health care, most preventable adverse events occur in the operating room. Surgical safety checklists have become a standard of care for safe operating room practice, but there is conflicting evidence for the effectiveness of checklists to improve perioperative outcomes in some populations. Our objective was to determine whether surgical safety checklists are associated with a reduction in the proportion of children who had perioperative complications.
  
  
  METHODS
  We conducted a retrospective cohort study using administrative health care databases housed at the Institute for Clinical Evaluative Sciences to compare the risk of perioperative complications in children undergoing common types of surgery before and after the mandated implementation of surgical safety checklists in 116 acute care hospitals in Ontario. The primary outcome was a composite outcome of 30-day all-cause mortality and perioperative complications.
  
  
  RESULTS
  We identified 14 458 and 14 314 surgical procedures in pre- and postchecklist groups, respectively. The proportion of children who had perioperative complications was 4.08% (95% confidence interval [CI] 3.76%-4.40%) before the implementation of the checklist and 4.12% (95% CI 3.80%-4.45%) after implementation. After we adjusted for confounding factors, we found no significant difference in the odds of perioperative complications after the introduction of surgical safety checklists (adjusted odds ratio 1.01, 95% CI 0.90-1.14, p = 0.9).
  
  
  CONCLUSIONS
  The implementation of surgical safety checklists for pediatric surgery in Ontario was not associated with a reduction in the proportion of children who had perioperative complications.
  
  
  BACKGROUND
  ClinicalTrials.gov, no. NCT02419053.
authors.affiliation: Department of Anesthesia (O'Leary, Wijeysundera, Crawford), University of Toronto; Department of Anesthesia and Pain Medicine (O'Leary, Crawford), The Hospital for Sick Children; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Wijeysundera); Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital; Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, and Institute of Health Policy Management and Evaluation (Wijeysundera), University of Toronto, Toronto, Ont. james.oleary@sickkids.ca.
authors.forename: James D
authors.initials: JD
authors.lastname: O'Leary
authors.affiliation: Department of Anesthesia (O'Leary, Wijeysundera, Crawford), University of Toronto; Department of Anesthesia and Pain Medicine (O'Leary, Crawford), The Hospital for Sick Children; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Wijeysundera); Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital; Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, and Institute of Health Policy Management and Evaluation (Wijeysundera), University of Toronto, Toronto, Ont.
authors.forename: Duminda N
authors.initials: DN
authors.lastname: Wijeysundera
authors.affiliation: Department of Anesthesia (O'Leary, Wijeysundera, Crawford), University of Toronto; Department of Anesthesia and Pain Medicine (O'Leary, Crawford), The Hospital for Sick Children; Li Ka Shing Knowledge Institute, St. Michael's Hospital (Wijeysundera); Department of Anesthesia and Pain Management (Wijeysundera), Toronto General Hospital; Cardiovascular Research Program, Institute for Clinical Evaluative Sciences, and Institute of Health Policy Management and Evaluation (Wijeysundera), University of Toronto, Toronto, Ont.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Crawford
mesh_terms: D000293:Adolescent; D057189:Checklist; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009864:Ontario / Q000453:epidemiology; D009873:Operating Rooms; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies