Retained Surgical Instruments and Sponges

A recent study done by Dr. Gawande at the Harvard School of Public Health revealed interesting data about an uncommon but dangerous medical practice. Dr. Gawande studied the risk factors for surgical objects remaining in body cavities after surgery. The study revealed interesting results that may impact how operating room procedures account for the implements they use during an operation.

The results of this study revealed that nearly 70% of retained objects, as they are legally referred to, were sponges used to create an adequate operating environment in an open cavity. These sponges are often applied rapidly to keep an incision free of fluids and in the process they are not accurately accounted for. Retention of these sponges is more likely to occur if inaccurate count is taken during the surgery. Taking a count of all surgical instruments, including sponges, is typically practiced during the preparation for a surgical procedure. The equipment is counted once again before exiting the operating room in attempt to prevent retention. But this count can be performed inaccurately, especially in cases of unplanned changes in procedures or in emergency situations in which proper preparation time is not allowed.

Retention of surgical objects can be very harmful to the patient. In fact, Dr. Gawande's study showed that one of the patients incurred a fatal retention. Most retentions resulted in another surgical procedure. This second procedure heightens the potential for infection and further harm to be caused. The 30% of objects that were not sponges included a wide array of medical instruments. It was also concluded that patients with a high body-mass index are more susceptible to retaining surgical instruments. In response to this study, many critics have suggested that for these high risk situations, surgical teams should perform mandatory x-rays of the cavity to prevent unnecessary retention.