Objective To explore the barriers and facilitators to implementing the WHO’s Surgical Safety Checklist (SSC) at a tertiary-level hospital in Croatia, a country with a publicly funded universal healthcare system. Design Focus group-based study which used Graneheim and Lundman’s qualitative content analysis approach. Setting and participants We used purposive sampling to gather participants who were representative of the usual surgical team: nurses, residents, anaesthesiologists and surgeons. Aside from this requirement, we set no specific inclusion or exclusion criteria. We conducted 6 focus groups (2 with nurses, 2 with residents, 1 with anaesthesiologists and 1 with surgeons) with 29 participants. The nurses were all female, the residents and surgeons were all male, and anaesthesiologists were mostly male (60%). Most participants had at least a bachelor’s degree (93%). The focus groups were held in person at the hospital’s Department of Surgery in Croatia and were conducted in the local language, based on a predeveloped topic guide. Results Our analysis revealed two distinct themes that were fundamentally independent of each other. The first concerned within-team hierarchies and relationships that prevented the SSC from being used as intended, while the second was related to a diverse set of resource and logistical constraints that had existed before the implementation of the SSC. Conclusions Understanding the barriers faced by healthcare providers is crucial in designing training programmes that could help integrate the SSC into routine surgical practice. Our findings highlight the importance of actively including members of the surgical team in the implementation of the SSC and implementing interventions for improving within-team communication.

Patients with laryngeal squamous cell carcinoma (LSCC) often develop other malignancies, most commonly second primary lung cancer (SPLC). This study aimed to estimate the incidence of SPLC in LSCC patients and evaluate whether pulmonary nodules on baseline thoracic computed tomography (CT) predict SPLC development. In this single-center retrospective cohort study, 243 patients with LSCC diagnosed from 2017 to 2024 at the University Hospital of Split, Croatia, were followed, of whom 26 (10.7%) developed SPLC. The median time from LSCC to SPLC diagnosis was approximately 1.2 years. Patients with LSCC had an approximately eightfold higher risk of developing an SPLC than the general population (standardized incidence ratio [SIR] 8.40; 95% confidence interval [CI] 5.48–12.30). Pulmonary nodules at diagnosis were the only predictor associated with the development of an SPLC (hazard ratio [HR] 2.37; 95% CI 1.09–5.13; p = 0.029), although this association weakened and lost significance when the analysis was restricted to metachronous tumors (HR 1.84; 95% CI 0.71–4.77; p = 0.207). Metachronous tumors were predominantly squamous cell carcinomas (83.3%), whereas adenocarcinoma was the most common histological type among synchronous tumors (50.0%; p = 0.022). Patients with SPLC had a shorter overall survival than those without it (median 5.4 vs. 8.0 years; log-rank p = 0.016). The presence of pulmonary nodules at LSCC diagnosis was associated with a higher risk of SPLC. However, these findings originate from a single center, and further studies are needed to determine whether stratification based on initial radiological findings can improve early detection of SPLC in patients with LSCC.