Checklists as a central part of surgical safety culture

The number of surgical procedures performed is increasing worldwide. In 2004, the number of major operations performed reached 281 million, i.e. approximately one operation per year for every 25 individuals. 1 However, the numbers of complications among surgical patients has also been increasing and this has become the greatest cause of death and disability worldwide. 2 A systematic review has demonstrated that one in every 150 hospitalized patients dies as a consequence of complications related to an adverse event and that almost two thirds of these deaths are associated with surgical treatment. Half of these adverse events are considered to be avoidable. the 1970s, following a series of air accidents, analysis on these events demonstrated that a combination of stress, fatigue, lack of communication and avoidable errors caused up to 80% of them. 5 Through use of safety checklists and continuous training for crews, the incidence of air accidents has continually fallen since then, despite significant increases in the volume of air traffic. These checklists are now used routinely in aviation and other high-complexity industries. e of checklists offers a singular opportunity to correct any problems before proceeding and provides awareness of situations that are still to come.