Relevance of World Health Organization surgical safety checklist to trauma and orthopaedic surgery.

Surgery like civil aviation is a risk-prone occupation. Civil Aviation has reported a death rate of less than 1 in a million exposures. On the other hand, surgery has a reported mortality rate of 100 per million surgeries. The National Reporting and Learning System (NRLS) database in England reported 152,017 'incidents' occurred during 4.2 million surgeries in 2008. Trauma and orthopaedic surgery accounted for 32.4 percent of these 'incidents'. Wrong-site surgery occurred in a total of 133 patients, with an incidence of 31.6 per million surgeries. A system to implement and maintain safe surgical practice is mandatory to prevent these 'incidents'. The factors identified in the genesis of these incidents are errors in decision making, lack of communication, leadership and teamwork. These human errors can easily be prevented using a formal structured communication, like the checklists. In 2008, the WHO published a set of guidelines to ensure the safety of surgical patients. In 2009, the checklist was modified with an intention to reduce major surgical complications and was proved to be effective. Wrong level spinal surgery needs special emphasis. There may be an increasing role for checklists in Trauma and Orthopaedic surgical practice to improve its safety profile by being procedure-specific.