Implementation of a specific Safety Check is associated with lower postoperative mortality in cardiac surgery

Abstract Introduction In cardiac surgery, a pre-incision safety checklist may decrease complications and improve survival. Until now it has not been demonstrated whether implementation of such a checklist indeed reduces mortality. Objective Introduction of a pre-incision safety checklist on mortality was studied in a large adult cardiac surgery population. Methods This prospective multicenter cohort study included 5,937 consecutive adult patients, undergoing cardiac surgery, between January 2015 and December 2015, in seven 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 2,718 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 Conclusion Application of a short pre-incision safety checklist in a mixed population of adult cardiac surgery patients is associated with significantly reduced 120-day mortality.