Mandatory Checklists May Not Reduce Surgical Complications: Study

While the use of surgical checklists has become a growing practice in many hospitals, as a means of reducing the risk of complications and medical mistakes, a new study is questioning the effectiveness of the procedure, finding that the use of surgical checklists failed to improve outcomes.  

Surgical checklists are designed to reduce the risk of problems such as performing surgery on the wrong part of the body or leaving operating tools inside patients’ bodies following a procedure. Experts consider wrong-site and wrong-patient surgery mistakes as “never” events, which should not happen if the surgeon and medical staff follow the appropriate standards of medical care.

While the practice first began to gain popularity in 2004, surgical safety checklists have gathered growing support worldwide and prior research has suggested that they help improve mortality rates and reduce infections following surgery. However, the findings of a new study published last week in the New England Journal of Medicine suggests that the checklists may not be as helpful as researchers previously believed.

Researchers surveyed all acute care hospitals in Ontario, Canada three months before and after surgical safety checklists were implemented. More than 200,000 surgical procedures were performed before and after checklist implementation. They compared surgical operative mortality rates, rate of surgical complications, length of hospital stay, rates of hospital readmission and emergency room visits within 30 days after discharge following other surgical procedures.

The rates were compared both before implementation of the checklists and after to determine if the checklists were linked to improved outcomes, such as lowered mortality rates or reduction of readmission.

Researchers found that the risk of death during a hospital stay or within 30 days following surgery remained the same after surgical checklists were implemented. The risk was 0.71% before the checklist was implemented and 0.65% after implementation. The differences were considered statistically insignificant.

The risk of surgical complication did not decrease either. Adjusted risk of surgical complications was 3.86% before checklists were used and 3.82% after they were implemented.

“Implementation of surgical safety checklists in Ontario, Canada, was not associated with significant reductions in operative mortality or complications,” the study’s authors concluded.

Previous observational studies have indicated that there is a link between improved surgical outcomes and the implementation of surgical safety checklists, prompting hospitals worldwide to implement the practice.

A 2010 study published in the New England Journal of Medicine by European researchers was one of many to add to the growing body of evidence supporting the move to using surgical checklists. The researchers in that study said using surgical checklists could result in a 31% decline in patient complications.

Another study published in the British Medical Journal 2011 found a link between the use of surgical checklists and a reduction in the mortality rates following surgery. Researchers found mortality rates among elderly patients in intensive care units (ICUs) dropped 10 percent faster than hospitals not using the checklists.

However the new research is in direct opposition of the prior findings, prompting researchers to search for more evidence.