Abstract
PurposeTo investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery.MethodsWe retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist’s effectiveness.ResultsThe sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%).ConclusionsThe SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
The definition of complication in spinal surgery is currently not clear
The majority of procedures were performed for oncological pathologies (499; 54.5%) and degenerative diseases (363; 39.7%)
We observed a reduction in the overall incidence of complications following the introduction of the World Health Organization (WHO) Safety Surgical Checklist: In 2010, the incidence of complications was 24.2% without the checklist, while in 2011 and 2012, following the introduction of the checklist, the incidence of complications was 16.7% and 11.7%, respectively (p < 0.0005)
Summary
The definition of complication in spinal surgery is currently not clear. It varies greatly both in different literature reports and between different surgical specialties [1,2,3,4,5,6]. Dindo and Clavien [4] defined a surgical complication as “any deviation from the ideal postoperative course that is not inherent to the procedure and does not comprise a failure to cure.”. The complication rate after spinal surgery ranges between 7 and 20% [1, 2, 7,8,9,10,11], while orthopedic surgery generally has a mean rate of complications of 5% [12]
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