Abstract
BACKGROUND: Safe anesthesia is fundamental to safe surgery and depends on facility readiness, team behaviors, and consistent adherence to safety standards such as the World Health Organization (WHO) Surgical Safety Checklist. Across the Arab region, variability in workforce capacity, equipment and supplies, and checklist implementation may contribute to uneven safety performance, yet multicountry data describing readiness and routine anesthesia safety practices remain limited. We therefore assessed facility readiness and clinicians’ knowledge, attitudes, and self-reported safety practices, and examined how checklist use and perceived barriers relate to these domains across fourteen Arab countries. METHODS: We conducted a multicountry online cross-sectional survey of anesthesia team members working in hospital operating theatres and procedural anesthesia locations across fourteen Arab countries. The survey evaluated facility readiness, knowledge, attitudes, and self-reported safety practices, and captured frequency of surgical safety checklist use and perceived barriers to safe anesthesia practice. RESULTS: Overall, facility readiness and participants’ knowledge, attitudes, and self-reported safety practices were generally high; however, routine checklist use was not universal. Commonly reported barriers included understaffing and workload pressure, as well as financial constraints affecting equipment and supplies. More frequent checklist use was associated with better safety-related performance across assessed domains, whereas a higher barrier burden was associated with poorer readiness and self-reported practice. CONCLUSIONS: Although anesthesia safety performance was generally favorable across surveyed settings, important implementation and systems gaps remain, particularly in routine checklist use and resource-related constraints. Strengthening workforce capacity, ensuring access to essential equipment and supplies, and embedding meaningful, high-fidelity checklist use may help reduce residual safety gaps and support safer anesthesia care across diverse hospitals in the Arab region. TRIAL REGISTRATION: Not applicable. (This study is an observational cross-sectional survey and did not involve prospective assignment to a health-related intervention.) SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13037-026-00482-2.