Safe Surgery Checklist Reduces Infections and Costs in Spine, Hip, and Knee Procedures

To evaluate the impact of the Safe Surgery Program on surgical site infection (SSI) rates in spinal procedures and total hip and knee arthroplasties. The analysis compared the pre-implementation (2006-2010) and post-implementation (2010-2022) periods to determine the effect of the program on SSI rate reduction.

We conducted a nested case-control study including adults (>18 y). Cases were patients with SSI matched 1:1 to controls by procedure type, gender, age, and operation date. Risk factors, antimicrobial agent use, hospital costs, and checklist adherence were analyzed.

A total of 142 patients were included in the analysis (71 cases and 71 matched controls). Most surgical procedures (84.5%) occurred after the implementation of the Safe Surgery Program, with 78.3% adherence to the World Health Organization checklist. In the analysis, blood transfusion was significantly associated with SSI (odds ratio = 2.67; 95% confidence interval: 1.04-6.82; p = 0.040), whereas a longer operative time showed a borderline trend (p = 0.050). SSI rates decreased from 2.0% to 0.7% after program implementation (p = 0.017). Hospital-wide antimicrobial agent consumption increased for cefazolin (+75 defined daily doses per 1,000 patient-days), cefuroxime (+10.6), and vancomycin (+10.2) during the same period, reflecting broader compliance with surgical prophylaxis protocols. Hospital costs were significantly lower among patients without SSI (p = 0.024).

Implementation of the Safe Surgery Program was associated with reduced SSI incidence and hospital costs in complex orthopedic procedures. Blood transfusion remained an important risk factor, highlighting the value of optimization of peri-operative management and adherence to surgical safety practices.