• Alexander J Spanjersberg, Jan Paul Ottervanger, Arno P Nierich, Speekenbrink Ron G H RGH Department of Cardiothoracic Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Wim Stooker, Marga Hoogendoorn, Dennis van Veghel, Saskia Houterman, and George J Brandon Bravo Bruinsma.
• Department of Anesthesiology and Intensive Care, Isala Heart Centre, Isala, Zwolle, The Netherlands. Electronic address: a.j.spanjersberg@isala.nl.
• J. Thorac. Cardiovasc. Surg. 2020 May 1; 159 (5): 1882-1890.e2.

IntroductionIn 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.ObjectiveIntroduction of a preincision safety checklist on mortality was studied in a large adult cardiac surgery population.MethodsThis 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.ResultsThe 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.ConclusionsApplication of a short preincision safety checklist in a mixed population of adult cardiac surgery patients is associated with significantly reduced 120-day mortality.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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