Perioperative Safety in Plastic Surgery

Abstract

INTRODUCTION: In October 2007, the World Health Organization (WHO) instituted the Safe Surgery Saves Lives Program, the cornerstone of which was a 19-item safesurgery checklist (SSC), in eight selected hospitals around the world. A cohort of 3,733 consecutive surgery patients before and 3,955 patients after the implementation of the checklist was then prospectively followed. After implementation, death rates decreased significantly from 1.5% to 0.8%, inpatient complications reduced from 11% to 7%, as did rates of surgical site infection and wrong-sided surgery, across all sites. Based on these impressive reductions in complications and mortality, our institution adopted the WHO SSC in April 2009, with additional measures specific to plastic surgery included, such as assuring presence of appropriate sizers/implants and administration of preoperative thromboembolic prophylaxis and antibiotics. Our purpose is to evaluate the efficacy and applicability of the WHO SSC in a multi-surgeon plastic surgery hospitalbased practice, by analyzing its effect on complication rates and outcomes. METHODS: A retrospective review of the morbidity and mortality data from the Department of Plastic Surgery at Loma Linda University Medical Center was conducted from 2005 to 2011. Data on morbidity and mortality before and after implementation of the WHO SSC was analyzed. RESULTS: All core measures and complications are presented for the past seven years. The most common unacceptable outcomes were wound-related, including infection, seroma and/or hematoma, dehiscence, and flap-related complications. Unfortunately, no significant decrease in the measured complications occurred after the implementation of the SCC. Although verifying appropriate administration of antibiotic, presence of appropriate equipment and materials, performing a preoperative formal pause, and verifying the execution of the other measures included in the SCC is critical, untoward outcomes after implementation of the checklist did not measurably decrease. In its current form as this time, the checklist does not appear to be efficacious in Plastic Surgery. CONCLUSION: While certain elements of the WHO SSC checklist are universal and should be adopted, certain specific aspects require modification to improve applicability in a plastic surgery-specific practice. This necessitates the creation of an ambulatory, surgical safety checklist specifically for plastic surgery.