Archive January 2016 XVII, No. 1

Strategies to Prevent Retained Objects

What you can do to ensure that nothing's left behind.

Camille Harlan, RN, JD

BIO

Count everything KEEP COUNTING AORN recommends counting all sponges, sharps, and related miscellaneous items at 5 different times.

Surgical items are mistakenly left inside patients 4,500 to 6,000 times a year. While reports of retractors, knife blades, scalpels, clamps and scissors found on post-op X-rays grab our attention, it's a less glamorous item that causes the most problems — surgical sponges, which account for 70% of items left behind, according to research studies and government data.

Retained items can cause perforation, granuloma, obstruction, infection and even death. Considering the risks associated with a second surgery to remove the item, the cost of a subsequent hospitalization (Medicare denies payment for these related costs) and the inevitable malpractice suit, it's hard to understand why more attention isn't given to preventing these costly mistakes. If money talks, then the medical and liability costs associated with retained objects — which easily exceed $200,000 — should be a compelling reason for you to do all you can to reduce the risk.

Complications can last a lifetime
Consider the case of an Ohio woman who underwent gastric bypass surgery in the spring of 2012. Following surgery, her initial complaints of abdominal pain and constipation after surgery were attributed to recovery and given little attention by providers. Over the course of the next 18 months, her pain became excruciating, her weight loss left her looking "wasted" and her intractable vomiting developed a fecal odor. Frustrated with her surgeon's failure to address her complaints, she went to a different hospital for evaluation.

The emergency department physician she visited immediately ordered a CT scan. The images showed a surgical towel, left behind after her surgery, imbedded and twisted around her intestines. She underwent multiple surgeries in an attempt to fix a perforated area and surrounding infection caused by the towel. She spent several weeks in a medically induced coma, but eventually passed away from the overwhelming complications.

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