“Safety First”: A Survey Assessing World Health Organization Surgical Safety Protocol Adherence in Nigerian Orthopedics

BACKGROUND: The World Health Organization (WHO) Surgical Safety Checklist (SSC) reduces peri-operative complications and mortality, yet its consistent adoption in low- and middle-income settings such as Nigeria may be limited by cultural, and training-related barriers. Objective: To evaluate awareness, use, and barriers to WHO SSC implementation amongst Nigerian orthopedic surgeons. MATERIAL AND METHODS: Cross-sectional survey amongst Nigerian orthopedic surgeons. 13-item electronic questionnaire assessing WHO SSC awareness, usage patterns, administration, perceived barriers, and SSC related education. Associations between professional grade and SSC compliance were examined using Fisher-Freeman-Halton exact testing. Binary logistic regression was performed to explore predictors of SSC noncompliance, reporting odds ratios with 95% confidence intervals. RESULTS: Thirty surgeons responded, (consultants 70.0%, senior registrars 20.0%, and registrars 10.0%). SSC awareness was 96.67%, with 90.0% reporting routine usage. Time constraints were associated with lower odds of compliance, but this did not reach conventional statistical significance (OR 0.128; 95% CI 0.012-1.311; P=0.083). Departmental resistance and insufficient training, although frequently reported, were not statistically significant predictors. Qualitative feedback highlighted persistent cultural and workflow related challenges. Checklist administration was predominantly nurse-led (73.33%), raising questions about shared responsibility. Despite high usage rates, barriers such as inadequate training (36.7%) and departmental resistance (20%) remain prevalent. CONCLUSIONS: WHO SSC awareness and reported routine use were high among Nigerian orthopedic surgeons; however, time pressure and persistent educational and cultural barriers may limit consistent adherence. Targeted curriculum integration, workflow optimization, interprofessional training, and continuous quality improvement may strengthen SSC implementation and surgical safety culture.