It is estimated that 1 in 5,5K patients across the United States will leave the operating room with a retained surgical object in their body.
In healthcare, retained surgical instrument is considered a never event, a term used to describe medical errors that are very serious, but preventable.
Never event is a term describing cases that involve retained surgical objects as well as cases of surgery being performed on the wrong person or the wrong body part.
What does retained surgical instrument mean?
Retained surgical instruments (RSI) in a patient after a surgical procedure simply refer to medical supplies accidentally left inside a patient's body after surgery. These medical errors often result in severe and potentially life-threatening infections for patients and can seriously implicate the healthcare professionals and medical care providers involved.
RSIs were not designed to be left in the body and are items that may be utilized during a surgical procedure. Examples of retained foreign bodies include sponges, towels, needles, knife blades, safety pins, broken scalpel tips, clamps, scissors, tweezers, forceps, suction tips and tubes, scopes, penrose drains. Many other devices may be inadvertently left in a patient's body.
Over two-thirds of the retained surgical objects cases involve surgical sponges while reports of retained needles and instruments are infrequent.
Retained surgical item cases are problematic because patients often don't know anything is wrong until the body reacts to the item through pain. At the point when the pain is severe, and this can take years, the item has become infected, and the patient will likely need emergency surgery.
Consider the following examples:
- A man has a surgical sponge left in his abdomen after a cesarean section. His stomach swells, his bowels shut down, and he requires emergency surgery to untangle the infected sponge from his small intestine.
- A woman goes to the hospital complaining of severe abdominal pain and unexplained weight loss. The cause is a sponge from a surgery that was performed the previous year. She ends up needing surgery to remove part of her intestine and has to spend weeks in a medically induced coma.
- After surgery performed on her to remove cancerous tissue from rectum and colon, a woman experiences complications. It's later discovered that a surgical sponge was left inside her abdominal cavity for several weeks. Due to complications from the infected sponge, she is disqualified from further cancer treatment. One year later, she passes away.
- A patient develops a wound infection at the site of an incision hernia repair performed ten weeks previously. Computed tomography shows an area of inflammation. Wound exploration under general anesthesia reveals a sponge.
Why do retained surgical items happen?
The problem can affect any surgical specialty and any surgical procedure. Unsurprisingly, patients undergoing emergency procedures are most at risk. However, even those who have routine procedures can have this problem if the surgical team encounters complications that create a chaotic operating environment.
As shown in some studies, patients with a high body mass index are more likely to be affected by retained surgical objects. However, the specific reason for this is unknown.
After a review of 254 cases, it was found that the abdominal/pelvic cavity/vaginal vault (74%) is the most common site for this type of error to occur, followed by the thoracic cavity (11%). The majority of cases of retained surgical objects involve sponges left in patients who've had abdominal surgery.
Risk factors for retained instruments:
- Operations performed on an emergency basis
- Body mass index
- Unexpected change in operation
- Multiple surgical teams
- Female sex
- Estimated blood loss
- Change in nursing staff during the procedure
- Incorrect counts recorded
- Operation theater time
- Procedures performed after 5 pm
Imaging is the key to diagnosis. Computed tomography is the modality of choice to exclude the presence of an RSI.
How to prevent retained surgical items?
Retained surgical objects are considered never events, that is why hospitals implement some practices to account for the tools used during surgical procedures. Some of the most common include:
- A manual pre- and post-surgery count of operating instruments, with the patient immediately taken to x-ray if there are missing items.
- Using sponges specially equipped with inventory bar-codes.
- Using radio-frequency detection systems. These systems have chips sewn into the pocket of the gauze and require surgeons to use a mat or a wand at the end of the procedures to verify no foreign material was left in the body.
The medical care cost necessary to fix complications from a retained surgical item is not paid by Medicaid, Medicare, and private insurers. Hospitals must take care of these costs on their own.
Contact a Miami medical malpractice lawyer
Any case involving retained surgical items falls under the umbrella of medical malpractice. Medical malpractice compensatory damages are difficult to estimate because they are based on a number of influencing causes, such as past and future medical bills and any loss of earnings or of earning capacity caused by the error. The Law Offices of Sean M. Cleary is dedicated to assisting you if you have been the victim in a case involving a retained surgical object and received treatment at hospitals or surgical centers in Miami-Dade, Monroe, Broward, Fort Lauderdale, and Palm Beach Counties.