The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. We aimed to assess the impact on major surgical complications of adding an aviation-based team-training program after checklist implementation.

We prospectively conducted a parallel group cluster trial between September 2011 and March 2013. Operating-room teams from 31 hospitals were randomly assigned to participate in a team-training program focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during hospitalization within the first 30 days after surgery. Using a difference-in-difference approach, we estimated the ratio of the odds-ratios (ROR) to compare changes in surgical outcomes between intervention and control hospitals.

We enrolled 22,779 patients, including 5,934 before and 16,845 after team training implementation. The risk of major adverse events fell from 8.8% to 5.5% in 16 intervention hospitals (adjusted OR, 0.57 ; 95% confidence interval [CI], 0.48 to 0.68 ; P<0.001) and from 7.9% to 5.4% in 15 control hospitals (0.64 ; 95% CI, 0.50 to 0.81 ; P<0.001), resulting in the absence of difference between arms (ROR, 0.90 ; 95% CI, 0.67 to 1.21 ; P=0.47). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.

Surgical outcomes improved substantially with no difference between trial arms. Successful implementation of an aviation-based team-training program appears to require modification and adaptation of its principles to the context of the surgical milieu.