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Certain factors increase the likelihood that sponges or instruments will be left inside a surgical patient

Leaving sponges or medical instruments inside surgical patients can lead to serious problems ranging from bowel perforation and blood infection to death. A new study estimates that 1,500 such cases occur each year in the United States, about one or more cases each year for a typical large hospital. The study reveals for the first time that instruments and sponges associated with surgery are more likely to be left behind in cases involving emergency surgery, obese patients, or unplanned changes in the surgical procedure.

In the study supported by the Agency for Healthcare Research and Quality (HS11886 and K02 HS11285), David M. Studdert, L.L.B., Sc.D., M.P.H., of Harvard University, and his colleagues reviewed medical records associated with all claims or incident reports of a retained surgical sponge or instrument filed between 1985 and 2001 with a large malpractice insurer in Massachusetts. For each case, they identified an average of four randomly selected control patients who underwent the same type of operation during the same 6-month period.

Overall, the study included 54 patients with a total of 61 retained sponges or instruments and 235 control patients. Over half (54 percent) of the foreign bodies were left in the abdomen or pelvis, 22 percent were left in the vagina, 7.4 percent were left in the thorax, and 17 percent were left elsewhere in the body. Over two-thirds (69 percent) of the patients with retained sponges or instruments required reoperation, and one died. These patients were more likely than controls to have had emergency surgery (33 vs. 7 percent) or an unexpected change in surgical procedure (34 vs. 9 percent). They also had a higher mean body mass index and were less likely to have had sponges and instruments counted, which is recommended for all open cavity surgeries (followed by x-ray or manual reexploration if not all materials are accounted for). Given the cost of more than $50,000 per case for malpractice claim expenses alone, a $100 plain x-ray following high-risk categories of operations could prove a cost-effective intervention, suggest the researchers.

See "Risk factors for retained instruments and sponges after surgery," by Atul A. Gawande, M.D., M.P.H., Dr. Studdert, E. John Orav, Ph.D., and others, in the January 16, 2003, New England Journal of Medicine 348, pp. 229-235.

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