M. A. Bartz-Kurycki1,2, K. T. Anderson1,2, D. M. Ferguson1,2, M. E. Curbo1,2, J. Bach1,2, A. A. Childs1,2, T. D. Parker1,2, A. L. Kawaguchi1,2, M. T. Austin1,2, L. S. Kao1, M. E. Matuszczak2,3, R. R. Jain2,3, K. P. Lally1,2, K. Tsao1,2 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Department Of Pediatric Surgery,Houston, TX, USA 3McGovern Medical School at UTHealth,Department Of Anesthesiology,Houston, TX, USA
Introduction: The surgical safety checklist (SSC) is a 3-phase tool created to reduce morbidity and mortality. Adult studies have demonstrated improved outcomes associated with SSC utilization. However, the pediatric surgical population has very low morbidity and mortality, therefore the association between SCC adherence and outcomes has been difficult to establish. The purpose of this study was to evaluate whether SSC adherence was associated with improved 30-day post-operative outcomes in pediatric patients.
Methods: An observational study of non-emergent pediatric surgical cases performed in a children’s hospital was conducted by trained observers (2017-2018). Degree of adherence (verbalization and confirmation by 2 or more parties) was defined as the proportion of checklist items completed. Pre-induction, pre-incision and debriefing phases were observed. Total adherence score was the proportion of items completed from all 3 phases combined. Thirty-day outcomes were determined by retrospective chart review and included surgical site infection, wound dehiscence, readmission, emergency department (ED) visits, unplanned reoperations, pneumonia, and urinary tract infection. The primary outcome was a composite of any complication. Logistic regression was used for analysis.
Results: 510 cases were observed for SSC adherence. Patients had a median age of 4.1 years (IQR 1.1-9.8 years). Most observed cases were performed by Pediatric General Surgery (26.9%), Otorhinolaryngology (24.9%), and Urology (21.6%). The median operative time was 33.9 minutes (IQR 19.7-68.8 minutes). Median total adherence score was 86.2 (IQR 66.7-96.0). SSC adherence differed by phase. Pre-incision phase adherence was greatest at 100% (IQR 96-100), followed by debriefing (90.9%, IQR 72.7- 100), then pre-induction (84.6%, IQR 53.8-100). Complications occurred in 57 patients (11.2%); ED visits were most common (64.9%), followed by readmission (38.6%), and SSI (19.3%). Operative time and age were not associated with presence of a post-operative complication. However, surgical specialty, greater pre-induction adherence, and greater total adherence were associated with reduced likelihood of any complication on univariate regression. After adjusting for age, case length, specialty and total adherence to the SSC, only greater total adherence and greater pre-induction adherence remained associated with decreased post-operative complications (Table).
Conclusions: This is the first study to demonstrate that increased SCC adherence is associated with improved patient outcomes in pediatric surgery. The data suggest that improving pre-induction checklist adherence may help prevent patient harm.
