Compliance and completeness of WHO Surgical Safety Checklist in a tertiary-level neurosurgical center in Nepal: a retrospective descriptive audit

One million deaths and seven million complications occur in an estimated 234 million procedures carried out worldwide each year; half of these deaths are preventable. Studies have reported a reduction in the mortality rate by 50% after the introduction of the WHO Surgical Safety Checklist (WHO-SSC). Surgical errors resulting from poor safety practices have had devastating outcomes; by identifying current practices and potential gaps in checklist adherence, this research aims to enhance patient safety and improve surgical outcomes. A retrospective, descriptive, cross-sectional study was performed at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences to assess the compliance and completeness of the WHO-SSC in 50 consecutive patients undergoing cranial and spinal surgery under general anesthesia before and after COVID (Jan–Feb 2020 and 2023). The difference in compliance and completeness in elective and emergency cases, as well as in the two timelines, was also evaluated. In 2020, there were 19 emergencies and 31 electives; and in 2023, there were 16 emergencies and 34 electives. The WHO-SSC was not filled in 21% of emergency cases in 2020 and in 38% of emergency cases in 2023. In elective cases, around 25% of cases didn’t have the WHO-SSC filled in both timelines. Regarding the completeness of the WHO-SSC, there was a stark difference noted in the elective and emergency cases in the Sign-In domain, with patient identity confirmation done in only 53% of cases and site marking in 20% of cases in emergency neurosurgery. WHO-SSC is a proven tool that helps reduce surgical errors, morbidity, and even mortality. If not regularly emphasized, the compliance with conducting WHO-SSC wanes over time, especially in emergency neurosurgery compared to elective procedures, which can result in devastating consequences.