Surgical checklist lowers complications in dog pacemaker surgery

Abstract

INTRODUCTION: To determine whether use of a surgical safety checklist (SSC) would reduce the rate of major complications after permanent transvenous pacemaker implantation in dogs. ANIMALS: The study included one hundred ninety-nine dogs undergoing pacemaker implantation for bradyarrhythmias at an academic teaching hospital. METHODS: A service-specific SSC was developed and implemented for cardiac catheterization procedures in 2015. Medical records were reviewed to extract relevant clinical and procedural data for cases with (SSC [+]) and without (SSC [-]) a checklist. Owners or referring veterinarians were contacted for outcome and survival data. RESULTS: Major complications occurred in 25/199 (12.6%) dogs. Incidence of major complications was significantly lower in SSC [+] dogs compared with SSC [-] dogs (1/45 procedures vs 24/144 procedures; p = 0.019). Dogs with SSCs were more likely to receive antibiotics within 5 min of the first incision (p = 0.0082) and to receive antibiotics every 90 min throughout the procedure as prescribed (p = 0.001) compared with dogs without SSCs. Incidence of cardiac death was lower in SSC [+] dogs compared with SSC [-] dogs (p = 0.0012), but checklist use was not associated with increased survival time (all-cause or cardiac). On average, 91% of checklist components were completed for each SSC; minor changes in record-keeping protocols could increase compliance. CONCLUSIONS: Use of an SSC was associated with a decrease in the major complication rate and an increase in compliance with antibiotic protocols during pacemaker implantation. Results of this study support the use of an SSC in veterinary cardiology procedures.