Effect of surgical safety checklist implementation on the occurrence of postoperative complications in orthopedic patients

Mona Boaz, Alexander Bermant, Tiberiu Ezri, Dror Lakstein, Yitzhak Berlovitz, Iris Laniado, Zeev Feldbrin

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Surgical adverse events are errors that emerge during perioperative patient care. The World Health Organization recently published "Guidelines for Safe Surgery." Objectives: To estimate the effect of implementation of a safety checklist in an orthopedic surgical department. methods: We conducted a single-center cross-sectional study to compare the incidence of complications prior to and following implementation of the Guidelines for Safe Surgery checklist. The medical records of all consecutive adult patients admitted to the orthopedics department at Wolfson Medical Center during the period 1 July 2008 to 1 January 2009 (control group) and from 1 January 2009 to 1 July 2009 (study group) were reviewed. The occurrences of all complications were compared between the two groups. results: The records of 760 patients (380 in each group) hospitalized during this 12 month period were analyzed. Postoperative fever occurred in 5.3% vs. 10.6% of patients with and without the checklist respectively (P = 0.008). Signifcantly more patients received only postoperative prophylactic antibiotics rather than both pre-and postoperative antibiotic treatment prior to implementation of the checklist (3.2% vs. 0%, P = 0.004). In addition, a statistically non-signifcant 34% decrease in the rate of surgical wound infection was also detected in the checklist group. In a logistic regression model of postoperative fever, the checklist emerged as a signifcant independent predictor of this outcome: odds ratio 0.53, 95% confdence interval 0.29-0.96, P = 0.037. conclusion: A signifcant reduction in postoperative fever after the implementation of the surgical safety checklist occurred. It is possible that the improved usage of preoperative prophylactic antibiotics may explain the reduction in postoperative fever.

Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalIsrael Medical Association Journal
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • Checklist
  • Complications
  • Postoperative fever
  • Safe surgery
  • Wound infection


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