Health News

Why Surgical Instruments Get Left Inside

Jan. 16, 2003 -- Accidents sometimes just happen, but certain factors can increase the risk of some serious medical mistakes happening more often.

A new study in the Jan. 16 issue of TheNew England Journal of Medicine shows that items such as metal clamps and other surgical instruments are more likely to be left inside the patient after surgery in emergency situations, after an unplanned change in surgical procedure, or when the patient is obese. Based on the nearly 29 million hospital surgeries performed each year, the researchers estimate that more than 1,500 cases of retained foreign objects occur annually in the U.S.

Researchers say leaving sponges or surgical instruments inside patients is one of the most persistent but poorly understood types of medical errors.

To find out what might increase the likelihood of this rare, yet potentially dangerous mistake, researchers looked at the records of a major medical malpractice insurer and identified 54 patients who had a total of 61 foreign objects left inside them after surgery. They then compared these cases to 235 patients who underwent similar surgical procedures without incident.

The researchers found that about a third of patients who had a foreign object left inside them had emergency surgery or an unexpected change in surgical procedure compared to less than 10% of the comparison group. Patients who had a sponge or instrument left behind were also more likely to be overweight.

Overall, researchers say having emergency surgery increased the risk of this type of medical error by nearly nine-fold, and an unplanned change in procedure increased the risk by about four-fold.

The researchers state that the Association of Operating Room Nurses has long required that only X-ray detectable sponges be used and that the sponges should be counted before and after surgery. If all of the sponges are not accounted for, examination by the surgeon or X-ray must be performed.

Previous studies have shown that some incidents have occurred because precautions weren't followed, but researchers say even when safety procedures are followed, some foreign objects still go undetected.

"Often when you hear about these kinds of cases, people assume it is due to negligence," says study researcher Atul Gawande, MD, MPH, of Brigham and Women's Hospital in Boston, in a news release. "But we found that these errors usually occur despite teams following proper procedures. These errors tend to occur in unpredictable situations, such as emergency operations, that challenge standard protocols."

"It's important to note ... that emergency situations may impact the effectiveness of an otherwise well-intentioned inventory of instruments," says Gawande. The way to further reduce these errors is to step-up the use of X-rays and CT scans to ensure that surgical objects are not left behind.