{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T14:25:43Z","timestamp":1761402343139,"version":"3.41.2"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T00:00:00Z","timestamp":1729209600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The World Health Organization Surgical Safety Checklist (SSC), now used by healthcare providers worldwide, has proved to be useful in the improvement of patients' health through the reduction of mortality and morbidity after surgery. In the Emilia\u2010Romagna region in Italy the SSC is accompanied by a document that registers any non\u2010conformity (NC) identified during SSC completion. This study aimed to investigate the association between surgical complications and checklist compliance, in terms of incompleteness and presence of NCs, using data from the Modena Local Health Unit (LHU).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from surgeries performed in the Modena LHU between 2018 and 2022, with their SSC and related NC document. We estimated relative risks (RRs) of complications fitting three modified Poisson regression models. Model 1 included checklist incompleteness and NC presence, Model 2 adjusted Model 1 for patients\u2019 sex and age group, and Model 3 adjusted Model 2 for the other potential confounders. We also performed a sensitivity analysis estimating the same three models including death outcomes as complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found an increased risk of complications for both checklist incompleteness (unadjusted RR [uRR]= 2.04; 95% confidence interval [CI]: 1.17 to 3.54) and presence of NCs (uRR = 2.35; 95% CI: 1.71 to 3.22). Results were consistent after adjustment and in the sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improving checklist compliance can reduce the risk of surgical complications. In particular, NCs are a risk factor that must be further investigated to better understand their relationship with complications. We believe that NCs data recording is helpful for both researchers in the scope of surgical complications, and healthcare professionals in the operating room.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.14208","type":"journal-article","created":{"date-parts":[[2024,10,18]],"date-time":"2024-10-18T07:38:12Z","timestamp":1729237092000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The association between surgical complications and compliance to the World Health Organization Surgical Safety Checklist: A retrospective analysis of hospital records"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9075-8282","authenticated-orcid":false,"given":"Nicole","family":"Rossi","sequence":"first","affiliation":[{"name":"School of Economics Sapienza University of Rome Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0627-2624","authenticated-orcid":false,"given":"Mario","family":"Cortina\u2010Borja","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3600-4654","authenticated-orcid":false,"given":"Luca","family":"Golinelli","sequence":"additional","affiliation":[{"name":"Modena Local Health Unit Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Bersani","sequence":"additional","affiliation":[{"name":"Modena Local Health Unit Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-8685","authenticated-orcid":false,"given":"Marco","family":"Geraci","sequence":"additional","affiliation":[{"name":"School of Economics Sapienza University of Rome Rome Italy"},{"name":"Arnold School of Public Health, University of South Carolina Columbia South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,10,18]]},"reference":[{"volume-title":"Safe Surgery","year":"2024","author":"World Health Organization","key":"e_1_2_8_2_1"},{"volume-title":"WHO Guidelines for Safe Surgery","year":"2009","key":"e_1_2_8_3_1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/1983-1447.2019.20180270"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QMH.0b013e318231357c"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9381"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezr179"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2011.02590.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-015-2772-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0911535"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000716"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa0810119"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182777fa4"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000003844"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001012"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2011.02525.x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2010.11.024"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31823779ae"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181d970e3"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(12)38032-X"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.7045"},{"key":"e_1_2_8_22_1","unstructured":"Regione Emilia\u2010Romagna Salute. Aziende sanitarie Irccs Asp: erogazione dell'assistenza.2022. Accessed May 13 2024.https:\/\/salute.regione.emilia-romagna.it\/ssr\/organizzazione\/aziende-sanitarie-irccs"},{"key":"e_1_2_8_23_1","unstructured":"Servizio sanitario regionale Emilia\u2010Romagna Azienda Unit\u00e0 Sanitaria Locale di Modena. L'Azienda USL di Modena.2024. Accessed May 13 2024.https:\/\/www.ausl.mo.it\/azienda\/"},{"key":"e_1_2_8_24_1","unstructured":"Agenzia sanitaria e sociale regionale \u2013 Regione Emilia\u2010Romagna. Raccomandazioni per la sicurezza in sala operatoria.2010. Accessed May 13 2024.https:\/\/assr.regione.emilia-romagna.it\/pubblicazioni\/rapporti-documenti\/raccomandazioni-per-la-sicurezzain-sala-operatoria"},{"key":"e_1_2_8_25_1","unstructured":"Servizio Assistenza Ospedaliera Regione Emilia\u2010Romagna. Linee Guida Flusso SSCL Surgical Safety Checklist.2016. Accessed May 13 2024.https:\/\/salute.regione.emilia-romagna.it\/siseps\/sanita\/sicurezza-chirurgia\/documentazione\/normativa"},{"key":"e_1_2_8_26_1","unstructured":"Servizio Assistenza Ospedaliera Regione Emilia\u2010Romagna. Linee guida SIChER\u2010 Sorveglianza delle Infezioni del sito Chirurgico.2016. 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