Safe surgery in pediatrics: An integrative review
DOI:
https://doi.org/10.33448/rsd-v15i1.50536Keywords:
Child health, Patient safety, Hospitalized child.Abstract
The adoption of measures that promote surgical safety is essential to prevent adverse events and improve clinical outcomes in pediatric patients. Thus, this review aims to analyze the scientific evidence on the use of innovative strategies related to pediatric surgical patient safety for the prevention of adverse events. This study analyzed scientific evidence on strategies aimed at ensuring the safety of pediatric surgical patients, with an emphasis on preventing adverse events. It is an integrative review conducted in the LILACS, PubMed, Scopus, and Web of Science databases. A total of 2,088 studies were identified; after applying exclusion criteria, 13 were included. Surgical checklists were the most commonly used tools. Innovations included process analysis, emergency protocols, error reporting, interviews, record reviews, adapted toys, and furniture. The engagement of children and their parents in the safety verification process was also highlighted. The implementation of these strategies showed proven benefits. However, adherence by professionals to completing checklists and by parents to the proposed actions remains a challenge, making it necessary to adopt measures that enhance participation.
References
Barkmann, C., et al. (2023). Pediatric surgery and self-reported anxiety in children and their parents: A psychometric analysis of the state-trait operation anxiety (STOA) questionnaire. Frontiers in Pediatrics, 11. https://www.frontiersin.org/articles/10.3389/fped.2022.987658/full
Bartz-Kurycki, M. A., et al. (2018). Adherence to the pediatric preinduction checklist is improved when parents are engaged in performing the checklist. Surgery, 164(2), 344–349.
Bellora, E., & Oliveira, M. (2013). Surgery checklist implementation to reduce clinical risk in the pediatric operating room. https://www.scopus.com/record/display.uri?eid=2-s2.0-84891476379
Bognár, A., et al. (2008). Errors and the burden of errors: Attitudes, perceptions, and the culture of safety in pediatric cardiac surgical teams. The Annals of Thoracic Surgery, 85(4), 1374–1381.
Botelho, L. L. R., Cunha, C. C. A., & Macedo, M. (2011). O método da revisão integrativa nos estudos organizacionais. Revista de Gestão e Sociedade, 5(11), 121–136. https://doi.org/10.21171/ges.v5i11.1220
Costa Rinaldi, L., et al. (2019). Adesão ao checklist de cirurgia segura: Análise das cirurgias pediátricas. Revista SOBECC, 24(4), 185–192.
Din, U., et al. (2025). Analysis of barriers to implementing the WHO surgical safety checklist in a tertiary care hospital of Peshawar. Indus Journal of Bioscience Research, 3(2), 534–543. http://induspublishers.com/IJBR/article/view/743
Ferraz, S. C. da S., et al. (2020). Use of nursing technologies for safe perioperative pediatric care. Revista Gaúcha de Enfermagem, 41, e20190144.
Fronk, E., & Billick, S. B. (2020). Pre-operative anxiety in pediatric surgery patients: Multiple case study analysis with literature review. Psychiatric Quarterly, 91(4), 1439–1451. https://doi.org/10.1007/s11126-020-09780-z
Goldstein, S. D., et al. (2014). The “weekend effect” in pediatric surgery: Increased mortality for children undergoing urgent surgery during the weekend. Journal of Pediatric Surgery, 49(7), 1087–1091.
Konfirst, C., Preston, S., & Yeh, T. (2015). Checklists and safety in pediatric cardiac surgery. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 18(1), 43–50.
Li, W. H. C., et al. (2016). Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatrics, 16(1), 36. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-016-0570-5
Moher, D., et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
Molavi-Taleghani, Y., Ebrahimpour, H., & Sheikhbardsiri, H. (2020). A proactive risk assessment through healthcare failure mode and effect analysis in pediatric surgery department. Journal of Comprehensive Pediatrics, 11(1), e103369. https://doi.org/10.5812/compreped.103369
Norton, E. K., et al. (2016). Operating room clinicians’ attitudes and perceptions of a pediatric surgical safety checklist at one institution. Journal of Patient Safety, 12(1), 44–50.
Norton, E. K., & Rangel, S. J. (2010). Implementing a pediatric surgical safety checklist in the OR and beyond. AORN Journal, 92(1), 61–71.
Oak, S., et al. (2015). Surgical checklist application and its impact on patient safety in pediatric surgery. Journal of Postgraduate Medicine, 61(2), 92–95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943428/
O’Leary, J. D., Wijeysundera, D. N., & Crawford, M. W. (2016). Effect of surgical safety checklists on pediatric surgical complications in Ontario. CMAJ, 188(9), E191–E198. https://doi.org/10.1503/cmaj.150523
Organização Mundial da Saúde. (2009). Segundo desafio global para a segurança do paciente: Cirurgias seguras salvam vidas (orientações para cirurgia segura da OMS). Organização Pan-Americana da Saúde; Ministério da Saúde; Agência Nacional de Vigilância Sanitária.
Pereira, A. S., Shitsuka, D. M., Parreira, F. J. & Shitsuka, R. (2018). Metodologia da pesquisa científica. Editora da UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.
Pires, M. P. O., Pedreira, M. L. G., & Peterlini, M. A. S. (2015). Surgical safety in pediatrics: Practical application of the pediatric surgical safety checklist. Revista Latino-Americana de Enfermagem, 23(6), 1105–1112. https://doi.org/10.1590/0104-1169.0573.2657
Short, H. L., et al. (2018). Trends in common surgical procedures at children’s and nonchildren’s hospitals between 2000 and 2009. Journal of Pediatric Surgery, 53(8), 1472–1477.
Silva, R. (2020). Safe surgery: Analysis of physicians’ adherence to protocols and its potential impact on patient safety. Revista Brasileira de Anestesiologia. https://www.scielo.br/j/rba/a/b9JbGzZQJ7J7r9X3f6RbP8L
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, Elsevier. 104(C), 333-9. Doi: 10.1016/j.jbusres.2019.07.039.
Tzanetos, D. R. T., et al. (2020). Implementation of a “threat and error” model in complex neonatal cardiac surgery patients to identify quality improvement opportunities. Cardiology in the Young, 30(6), 860–865. https://doi.org/10.1017/S1047951120001432
Wang, Y. L., et al. (2014). Operating room within the neonatal intensive care unit: Experience of a medical center in Taiwan. Pediatrics & Neonatology, 56(4), 220–225.
Yaseen, S. J., et al. (2025). Multicenter audit of operating room staff compliance with the surgical safety checklist: A cross-sectional study from a low- and middle-income country. BMC Health Services Research, 25(1).
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Copyright (c) 2026 Gisele Aparecida Soares Cunha de Souza, Nathália de Matos Souza, Letícia do Nascimento Sarabia Vieira, Caroline Fernanda Sanches Dal Pozzo, Maria Paula de Oliveira Pires, Rodolfo Luis Korte, Horácio Tamada

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