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Does the WHO Surgical Safety Checklist Need Modification for Orthopaedic Surgery Practices? A Cross-Sectional Survey Among Indian Orthopaedic Surgeons

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Abstract

Background

It is well known that the implementation of the WHO surgical safety checklist (SSC) leads to improved operating room team coordination and reduced perioperative complication and mortality rates. Although it is proven to be beneficial worldwide, its awareness and usage need to be evaluated in a diverse country like India. As orthopaedic surgeries involve implants and tourniquet usage, it is important to evaluate the applicability of WHO SSC specifically to orthopaedic surgeries, and whether any modifications are needed.

Materials and Methods

A web-based cross-sectional survey was conducted among Indian Orthopaedic Surgeons with a pre-defined questionnaire regarding awareness, usage and suggestions to modify the existing WHO SSC (2009) for orthopaedic surgeries.

Results

513 responses were included for final analysis. 90.3% of surgeons were aware of the surgical safety checklist; however, only 55.8% used it routinely in their practice. The awareness of SSC availability was 1.85 times more among younger surgeons (< 20 years of experience) than among those with > 20 years of experience. 17% of surgeons thought the usage of SSC was time-consuming and 52.4% of participants felt a need to modify the existing WHO SSC (2009) for orthopaedic surgeries. 34.5% recommended the inclusion of the patient blood group in the “Sign-in” section, 62.77% proposed the inclusion of details about the tourniquet, whereas only 6.63% suggested adding about surgical implant readiness in the “Time-out” section and 72.7% suggested including a check to make sure the tourniquet was deflated, removed and also recording of the total usage time during the “Sign-out” section.

Conclusion

Despite high (90%) awareness among Indian Orthopaedic surgeons, they have limited usage of the WHO SSC in their practice. Identifying barriers and considering modifications for orthopaedic surgeries, like details about tourniquet usage during the “Time-out” section and a check to ensure it was removed during the “Sign-out” section, will improve patient safety and outcomes.

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Authors and Affiliations

  1. Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Karthick Rangasamy, Nirmal Raj Gopinathan & Mandeep Singh Dhillon

  2. Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India

    Madhan Jeyaraman

  3. Department of Community Medicine, Faculty of Medicine-Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India

    Preethi Selvaraj

  4. Sudha Women, Child Care and Fertility Centre, Coimbatore, Tamil Nadu, India

    Divyalakshmi Arumugam

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  1. Karthick Rangasamy
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  2. Madhan Jeyaraman
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Correspondence to Madhan Jeyaraman.

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Rangasamy, K., Jeyaraman, M., Selvaraj, P. et al. Does the WHO Surgical Safety Checklist Need Modification for Orthopaedic Surgery Practices? A Cross-Sectional Survey Among Indian Orthopaedic Surgeons. JOIO 58, 278–288 (2024). https://doi.org/10.1007/s43465-024-01096-5

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