1. Introduction

Patient safety encompasses all means of removing sea or prevent events unwanted or damage from medical care processes [ 1] . The operating room is a unit of great complexity, with  a high potential of adverse events for the patient  [2.3] thus, the improvement of security rity of patients has become a priority croissante in  the hospitals.  According to several studies, surgery is responsible for a large part of adverse and avoidable events related to care[2].                                                                                                                                                 In order to improve these results, the WHO has set up a program called “Safe Surgery Saves Lives” [6,7]. The implementation of this program required a “surgical patient safety” checklist (CL). The results showed a reduction in the rate of post-operative complications and mortality [4]. Based on these data, it has been concluded that the checklist can improve surgical outcomes [6, 8, 9,10]. Hence our motivation to assess the extent to which the checklist has been implemented at the HNZ.

2. Patients and Method

We conducted a descriptive cross-sectional study with prospective data collection from October 1 to December 31, 2023. All patients admitted to the operating room for scheduled surgery were included. We observed the completion of the checklist in the various operating rooms. Application of the checklist was assessed by two indicators: compliance and completeness (Table 1). The variables studied were socio-demographic data, ASA classification, anesthesia technique, antibiotic prophylaxis and adverse events. Data analysis was performed using Microsoft Word 2010, Microsoft Excel 2010, SPSS 22. Prior authorization was obtained from the HNZ administration, and staff anonymity was preserved.

Table1: Methodology for calculating the compliance rate and the completeness rate

3. Results

During the study period, 698 procedures were carried out. The checklist was applied to 306 patients, i.e. 43.84% compliance. The average age of patients was 24.46 ±24 years, with extremes of 15 days and 85 years. The 0-20 age group was the most represented, with 56.21% of cases (Table 2).

Table 2: Distribution of patients according to sociodemographic characteristics

Males predominated in 66.01% of cases, i.e. a sex ratio of 1.94. All patients had undergone CPA. ASA1 and ASA2 accounted for 92.5% of cases. Altemeier class1 represented 71.57% of procedures performed. General anaesthesia (GA) was the most common anaesthetic technique, accounting for 69.93%. In 63.4% of cases, antibiotic prophylaxis was administered 30 min before the procedure (Table 3). Adverse events occurred in 15.03% of patients, of which 56.5% were of cardiovascular origin and 30.4% of respiratory origin.

Table 3: Detailed distribution according to the completeness by question of the CL

4. Discussion

We studied the implementation of the checklist in the operating theatres of the Hôpital National de Zinder (HNZ). The mean age of our patients was 24.46 years. This was lower than those of Haynes et al (USA) [4], Collazos C et al (Colombia) [9], Van Klei et al (Netherland) [10], who found respectively 46.7, 48.5 and 54.2 years. The average age of our series can be explained by the youthfulness of the African population in general, and of the Nigerian population in particular [11]. We recorded a male predominance with a rate of 66.01% (n=202), i.e. a sex ratio of 1.94. This result was similar to that reported by Van Klei et al (Netherland) [10] and Sow et al (Mali) [12], who reported 52.6% and 60.3% respectively. In contrast, Haynes et al (USA) [4], Kabey et al (Congo) [13] and De Vries et al (Netherland) [8] reported 57.6%, 67.8% and 52.6% of women respectively. Our result could be explained by the absence of an obstetrics and gynecology department at the national hospital in Zinder, and the proportion of women in the general population in Niger [11]. Patients classified as ASA1 and ASA2 were in 42.2% and 50.33 respectively. The same observation was made by Sow et al (Mali) [12], Kabey et al (Congo) [13] with a rate of 94.7% and 91.9%. Clean surgery (Altemeir class 1) accounted for 71.57% of cases, which was higher than the 28.3% reported by Sow et al (Mali) [12]. General anaesthesia was the most common technique, with a rate of 69.93%. However, for Van Klei et al (Netherland) [10], Kabey et al (Congo) [13], Sow et al (Mali) [12], general anaesthesia was used in 96.99%, 87.6% and 87.2% of cases respectively. Antibiotic prophylaxis was administered in 63.4% of cases. In our study, 46 patients (15.03%) experienced adverse events, 56.5% of which were of cardiovascular origin and 30.4% of respiratory origin. On the other hand, Sow et al (Mali) [12] recorded 38% of cardiovascular adverse events and 25.6% Diop et al (Mali) [15] also made the same observations. On the other hand, Lahmar (Algeria) [16] found a predominance of respiratory adverse events in 73% of children under 3 years of age, and cardiovascular adverse events in 57% of adults. We reported a checklist compliance rate of 43.84%, which was lower than that found by Sewell et al (UK) [17], Fourcade et al (France) [6] and Sow et al (Mali) [12], who reported 96.9%, 95.8% and 77% respectively. However, Sewell et al (UK) [17] found a compliance rate of 7.9%. Completion rates were 39%, 68% and 81% respectively for Van Klei et al (Netherland) [10], Fourcade et al (France) [6] and Sow et al (Mali) [12] 

5. Conclusion

The compliance rate at our facility was quite encouraging. Efforts must be made to introduce the checklist on a permanent basis.

Competing interests

No

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