Value of a preoperative checklist for laparoscopic appendectomy and cholecystectomy

Abstract

Laparoscopy is a complex technique where incidents related to equipment failure/malfunction commonly occur. The purpose of the WHO preoperative safety checklist is to significantly reduce surgically associated complications and mortality. The goal of this study was to show that a preoperative checklist for laparoscopy could improve procedure efficiency by reducing lost time due to these incidents. This prospective study compared the occurrence of incidents related to equipment, patient installation and the time loss attributed to these incidents, before and after the initiation of a preoperative checklist. Two hundred consecutive laparoscopic procedures (appendectomies and cholecystectomies) were studied; the first hundred without the preoperative checklist and the second hundred after the initiation of this laparoscopic checklist. The risk of at least one incident to occur during the procedure was increased 3-fold ([1.36 vs. 6.64], P=0.007) when the checklist was not used compared to when the preoperative checklist was used. Likewise, the number of incidents increased 2.4-fold ([1.15; 5.01], P=0.02), compared to when the preoperative checklist was used. The checklist significantly reduced the proportion of incidences during which time was lost from 22% to 10% (P=0.03). A preoperative checklist for laparoscopic procedures is feasible and seems useful to prevent adverse events in the operating room.