ATLANTA, Jan 15: Scrawl on the patient with a permanent marker to show where the surgeon should cut. Ask the person’s name to make sure you have the right patient. Count sponges to make sure you didn’t leave any inside the body.

Doctors worldwide who followed a checklist of steps like these cut the death rate from surgery almost in half and complications by more than a third in a large international study of how to avoid blatant operating room mistakes. The results — most dramatic in developing countries — startled the researchers.

“I was blown away,” said Dr Atul Gawande, a Harvard surgeon and medical journalist who led the study, published in Thursday’s New England Journal of Medicine.

US hospitals have been required since 2004 to take some of these precautions. But the 19-item checklist used in the study was far more detailed than what many institutions follow.

“Most of these things happen most of the time for most patients, but we need to make it so that all these things happen all the time for all patients, because each slip represents an opportunity for harm,” said Dr Alex Haynes of the Harvard School of Public Health, one of the study’s authors.

The checklist was developed by the World Health Organisation and includes measures such as these:

— Before the patient is given anaesthesia, make sure the part of the body to be operated on is marked, and make sure everyone on the surgical team knows if the patient has an allergy.

— Before the surgeons cut, make sure everyone in the operating room knows one another and what their roles will be during the operation, and confirm that all the needed X-rays and scan images are in the room.

— After surgery, check that all the needles, sponges and instruments are accounted for.

That checklist was tested in 2007-08 in eight cities around the world — Seattle, Toronto, London, New Delhi, Auckland, Amman, Manila and Ifakara (Tanzania). Heart and paediatric cases were excluded.

Before the checklist was introduced, 1.5 per cent of patients in a comparison group died within 30 days of surgery at the eight hospitals. Afterwards, the rate dropped to 0.8 per cent — a 47 per cent decrease.

The biggest decreases were in developing countries, with the combined death rate for Jordan, India, Tanzania and the Philippines falling 52 per cent. There was no significant difference in deaths in the wealthiest countries.—AP