Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Abstract

OBJECT 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.

Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?

“…Although several investigators have challenged the efficacy of the SSC, it has shown repeated success in reducing preventable postoperative complications, length of hospital stay, and overall mortality [18,[37][38][39]. In addition, multiple investigators have concluded that the implementation of the SSC in multiple institutions has improved communication, efficiency, and attention to routine details in the operating room.…”

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

“…A comprehensive literature search on reoperations in neurosurgery revealed only 4 studies on the topic, 5,6,8,9 with no studies specifically examining 48-hour reoperation rates.…”

“…T hirTy-day readmission and reoperation rates have been used as quality indicators across surgical specialties. 1,2,[4][5][6][8][9][10][11][12]14 This relatively long time interval (30 days) enables one to capture complications resulting from complex interplays among preoperative, intraoperative, and postoperative factors following the index surgery. For example, surgical infection could be a direct result of breaches of proper sterile technique, but it could also result from poor wound care or lack of access to medical care.…”

The effects of safety checklists in medicine: a systematic review

“…Favourable patient outcomes were associated with the use of WHO SSC in several studies with reductions in complications 10,19,92,[94][95][96][97][98][99][100][101][102][103][104] , mortality 10,11,62,88,94,102,105,106 , unplanned reoperations 10,19,99,107 , and unplanned readmissions 91,98,108 , LOS 19,89,105,106 , while other studies reported no significant changes after introduction of the WHO SSC as to complications 89,93,106,[109][110][111][112][113][114] , mortality 19,89,91,93,95,[97][98][99]…”

“…Our updated review (table 1, page 13) found several original studies reporting reductions in reoperations with WHO SSC use 10,19,87,107 , but also studies reporting no such effects 89, 92, 97-99, 101, 111 . All studies, except one 107 , reported on reoperations as a sub-analysis, and not as a main outcome.…”