Journal Scan: In veterinary surgery, check thrice, cut once

As any carpenter knows, the adage "measure twice, cut once" highlights the wisdom of careful planning. Just as a rushed carpenter can cut a board too short by measuring only once, the veterinary team can make simple mistakes that can result in dire consequences for their surgical patients. Surgical complications can range from mild (such as a seroma at the incision site) to severe (such as major dehiscence, profound hemorrhage, multiple organ failure or anesthetic death).

A major study coordinated by the World Health Organization (WHO)¹ and other follow-up studies have found that utilizing surgical safety checklists reduces postoperative complications and mortality in people. A recent prospective study² performed at a university animal hospital in Sweden examined the use of surgical checklists in cats and dogs to see if a similar reduction in postoperative complications was found.

What they did

Check out these checklists

To see the surgical safety checklist used in this study, click on the link to the abstract here.

To get a downloadable surgical safety checklist based on the one used in this study and adjusted by Amy Van Gels, DVM, and Jennifer Wardlaw, DVM, MS, DACVS, click here.

The postoperative complications of 520 dogs and cats undergoing major soft tissue and orthopedic surgeries were evaluated. The surgical safety checklist, which was based on the one created by WHO, was read aloud at three essential time points:

• Before anesthetic induction,
• Before the start of surgery, and
• Before recovery.

The checklists were not used for the first 300 patients but were completed for the final 220. Any complications that occurred during the four to six weeks following surgery were recorded and classified as mild, moderate or severe. The complications between the two groups were then compared.

What they found

A total of 67 postoperative complications occurred. There were significantly more complications in patients whose surgeries did not include a safety checklist (17%) as compared with the group that did (7%). The most common types of complications were:

• Unexpected additional surgery
• Surgical site infection
• Wound complication without infection (such as dehiscence, delayed healing or seroma formation).

There were significantly fewer surgical site infections and wound complications after the implementation of the safety checklist. A significant difference was not found between the groups regarding the severity of complications or mortality. However, the low number of deaths (one with the checklist and four without) is not sufficient to accurately compare mortality rates between the groups.

Take-home message

Similar to what is seen in people, the use of a surgical safety checklist reduces postoperative complications in dogs and cats. This may be due to the combination of improved surgical team communication, identification of medication errors or equipment oversights, antibiotic administration, and sterility checks, or an overall improvement in the “safety culture” of the practice.

Considering a surgical safety list's potential to reduce postoperative complications, practices should consider implementing one. The list should be modified to fit the practice's needs and then updated annually. Keeping it short and easy to use is vital for continued staff compliance. Utilizing the surgical safety checklist is a simple and quick way to plan ahead-to check thrice and cut once-to improve patient outcomes and client satisfaction.

Link to abstract: https://onlinelibrary.wiley.com/doi/abs/10.1111/vsu.12482

References

1. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New Engl J Med 2009;360:491-499.
2. Bergström A, Dimopoulou M, Eldh M. Reduction of surgical complications in dogs and cats by the use of a surgical safety checklist. Vet Surg 2016;45:571-576.  

Dr. Amy Van Gels practiced companion-animal medicine for seven years before becoming a freelance medical writer and editor. Drawing on her practical experience, she creates clinically relevant articles for veterinarians and their staff, training documents for sales teams, and educational materials for pet owners. Dr. Van Gels is passionate about relaying accurate medical information to everyone who impacts patient care, at every level of medical knowledge.