Lay Summary When part of the bowel is removed, the two ends are reconnected; this is called an anastomosis. Leakage of such an anastomosis is a serious threat to a patient’s health. Doctors can lower the risk of anastomotic leak by using a ‘care bundle’. This is a set of six steps to make conditions in the operating room as good as possible. Studies in which these steps are optimized under close supervision show very good results. However, in everyday hospital practice, where time and resources are limited, results might not be as strong. The authors wanted to find out if using a short safety checklist during surgery could improve conditions in the operating room without extra training, supervision, or feedback from the surgical team. The authors studied patients in ten hospitals in different countries from September 2021 to December 2024. The authors compared two groups: the checklist-only group (the surgical team used a checklist for checking the operative conditions before connecting the bowel ends); and the care bundle group (the surgical team used the checklist, then followed the full care bundle, and got feedback on how well they followed it). The authors looked mainly at how many risk factors for anastomotic leak were present during the surgery. The authors also looked at other results, such as problems after surgery, leak rates, and deaths. The authors included 1256 patients (372 checklist-only patients and 884 care bundle patients). Patients in the checklist-only group had an average of 1.81 risk factors. Patients in the care bundle group had an average of 1.63 risk factors. Death rates and length of hospital stay were similar in both groups. Patients in the checklist-only group had more complications after surgery (26.6% versus 18.3%). The leakage rate was slightly higher in the checklist-only group (8.9% versus 6.2%), but the difference was not clear enough to be sure. Using the full care bundle with feedback improved conditions during surgery and reduced the number of complications after bowel surgery. Using the checklist alone helped, but it was not as effective as combining it with the care bundle and feedback.
Boukje T. Bootsma (Mon,) studied this question.