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Effect of surgical safety checklists on pediatric surgical complications in Ontario
James D O'Leary1, Duminda N Wijeysundera2, Mark W Crawford2
1Department 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.
Insights
Surgical safety checklists did not reduce complications in children undergoing surgery in Ontario. The study found no significant difference in perioperative complications before and after checklist implementation.
Area of Science:
- Healthcare quality improvement
- Pediatric surgery outcomes
- Patient safety research
Background:
- Preventable adverse events in healthcare are frequent in operating rooms.
- Surgical safety checklists are standard practice, but their effectiveness in improving perioperative outcomes in pediatric populations is debated.
- Conflicting evidence exists regarding the impact of checklists on patient outcomes.
Purpose of the Study:
- To determine if surgical safety checklists are associated with a reduction in perioperative complications in children.
- To evaluate the effectiveness of mandated surgical safety checklists in pediatric surgery.
- To assess the impact of checklist implementation on patient safety in pediatric surgical care.
Main Methods:
- Retrospective cohort study using administrative healthcare databases in Ontario.
- Comparison of perioperative complications in children before and after mandated surgical safety checklist implementation.
- Analysis of 14,458 procedures pre-checklist and 14,314 post-checklist.
Main Results:
- The proportion of children experiencing perioperative complications was 4.08% before and 4.12% after checklist implementation.
- No statistically significant difference in the odds of perioperative complications was observed after checklist introduction (adjusted odds ratio 1.01).
- The 30-day all-cause mortality and perioperative complication composite outcome did not significantly change.
Conclusions:
- Implementation of surgical safety checklists in Ontario was not associated with a reduction in perioperative complications for pediatric surgical patients.
- The study suggests that checklists alone may not be sufficient to improve outcomes in this population.
- Further research may be needed to identify factors that contribute to perioperative complications in pediatric surgery.
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).
Interpretation:
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.
Trial Registration:
ClinicalTrials.gov, no. NCT02419053.
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