Implementation of a specific safety check is associated with lower postoperative mortality in cardiac surgery

J Thorac Cardiovasc Surg. 2020 May;159(5):1882-1890.e2. doi: 10.1016/j.jtcvs.2019.07.094. Epub 2019 Aug 28.


Introduction: In cardiac surgery, a preincision safety checklist may decrease complications and improve survival. Until now, it has not been demonstrated whether the implementation of such a checklist indeed reduces mortality.

Objective: Introduction of a preincision safety checklist on mortality was studied in a large adult cardiac surgery population.

Methods: This prospective, multicenter cohort study included 5937 consecutive adult patients, undergoing cardiac surgery, between January 2015 and December 2015, in 7 Dutch non-academic cardiac centers. The Isala Safety Check (ISC) is a short checklist addressing specific cardiac surgery safety items, in combination with a concise postinduction transesophageal echocardiography, which was gradually over time introduced in the 7 hospitals during 2015. We compared 120-day mortality and major complications between patients undergoing surgery with or without the use of the ISC. Propensity matching and Cox regression analyses were performed to adjust for potential confounders.

Results: The ISC was applied in 2718 patients (46%). Comorbidity and age were comparable in both groups. In the ISC group, 120-day mortality was significantly lower (1.7% vs 3.0%; P < .01). Both after propensity matching (hazard ratio, 0.44; 95% confidence interval, 0.22-0.87) and Cox regression analysis (hazard ratio, 0.56; 95% confidence interval, 0.35-0.90), the use of the ISC was still associated with reduced 120-day mortality. Deep sternal wound infection, surgical re-exploration, and stroke were not significantly different between both groups.

Conclusions: Application of a short preincision safety checklist in a mixed population of adult cardiac surgery patients is associated with significantly reduced 120-day mortality.

Keywords: adult cardiac surgery; best practice; mortality; outcome; patient safety; safety checklist.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / methods
  • Cardiac Surgical Procedures* / mortality
  • Checklist*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Safety*
  • Perioperative Care
  • Postoperative Complications* / mortality
  • Postoperative Complications* / prevention & control
  • Prospective Studies