Objectives: Surgical safety checklists (SSCs) are widely used tools aimed at reducing postoperative complications and mortality. While compliance is generally high, adherence to individual checklist sections and completeness can vary. This study aimed to assess compliance and completion rates of a locally modified 6-section SSC. Methods: We conducted a retrospective analysis of all inpatient and outpatient surgeries performed at a secondary-level hospital in northeastern Switzerland between January 1 and March 31, 2023. The presence and completeness of the scanned SSCs in the electronic medical records were evaluated. Multivariable logistic regression models were used to identify factors associated with missing or incomplete SSCs. Results: A total of 2376 surgeries were analyzed. Overall ,SSC compliance was high, with a scanned checklist present in 98% (n=2329) of cases; however, only 73% (n=1734) were fully completed. Missing or incomplete SSCs were more frequent in emergency procedures, outpatient surgeries, cases with local anesthesia, procedures performed on Fridays, certain surgical departments, lower-volume operating rooms, and earlier positions in the surgical schedule. Multivariable analysis confirmed that emergency procedures and the use of local anesthesia were independently associated with lower odds of full SSC completion. No clear associations were found with age, sex, health insurance type, or whether procedures were performed during regular operating hours. The “Sign-In” and “Team Time-Out” sections had the highest completion rates, whereas “Patient Ready for Operating Room” and “Sign-Out” were most frequently omitted. Conclusions: This study demonstrated a high overall rate of SSC compliance, though variation among checklist sections was observed. Specific contexts—particularly emergency and outpatient settings—were associated with reduced completeness, indicating opportunities for targeted quality improvement.
Wegner et al. (2026) studied this question.