Oops! What did your surgeon forget in your body?

Nurse handing instrument to surgeon. (Jupiterimages)
Nurse handing instrument to surgeon. (Jupiterimages)

OK, don’t worry. It is not that common. In an article published in the Journal of the American College of Surgeons (January 2013) titled, “Retained Surgical Items: A Problem Yet to Be Solved,” by Stanislaw P.A. Stawicki, MD, and others says retained surgical items (RSI) continue to occur. But the exact numbers are difficult to document due to the low frequency of RSI in a single institution and due to the medicolegal implications.

Literature suggests retained surgical items have traditionally been estimated to occur at a rate of 0.3 to 1.0 per 1,000 abdominal operations, and approximately 1 in 8,000 to 18,000 of all inpatient operations.

Seven teaching institutions were invited to participate in this retrospective, multicenter, case-control study of RSI risk factors was conducted between January 2003 and December 2009. Fifty-nine RSIs and 118 matched controls were analyzed (RSI incidence 1 in 6,975 or 59 in 411,526). Retained surgical items occurred despite use of confirmatory x-rays (13 of 27 instances) and/or radiofrequency tagging (2 of 32 instances).

The researchers concluded:
-higher body mass index

-unexpected intraoperative events
-longer procedure duration and
-occurrence of any safety omissions like an incorrect count were associated with increased RSI risk.

Trainee presence was associated with 70 per cent lower RSI risk compared with trainee absence. The researchers are not sure why this would be the case. This requires further study. They further say, “Our findings highlight the need for zero tolerance for safety omissions, continued study and development of novel approaches to RSI reduction, and establishing anonymous RSI reporting systems to better track both the incidence and risks associated with this problem, which has yet to be solved.”

As one can expect, the operating room is a complex environment where technology, team dynamics, potent pharmaceuticals, and technically difficult operations create high potential for adverse events.

The researchers highlight at least three major obstacles to reducing the incidence of RSI, including locating missing items identified by an incorrect count, reducing the rate of incorrectly-correct counts, and improving team attentiveness and compliance with safety procedures and documentation.

If you are having surgery in the near future then remember, the incidence of retained surgical items is extremely small. The people who work in the operating rooms are highly trained and dedicated and your safety, I am sure, is their first concern.

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