Despite rigorous counting protocols, as well as medical society-driven awareness efforts, surgical sponges are still unintentionally left inside patients after wound closure. And despite their use, X-rays do not provide definitive proof against sponge retention.1

the problem of retained surgical sponges

Visually searching for missing sponges lengthens procedure time, increases the risk of infection and exposes the patient to prolonged anesthesia.4

  • Miscounts occur in 1 out of every 150 procedures5
  • Average added OR time per miscount: 20 minutes6
  • Average cost of OR time: $62 per minute6
  • Average cost of an X-ray to address sponge miscounts: $286-$7057,8

Retained sponges result in costly re-operative expenses, legal battles and a compromised hospital reputation. For more information, go to Healthcare Economics.


  1. Egorova, PhD, Natalia N., Moskowitz A, MD, Gelijns A, PhD, Weinberg A, MS, Curty J, BS, Rabin-Fastman B, MS, Kaplan H, MD, Cooper M, MD, Fowler D, MD, Emond J, MD, Greco G, PhD. Managing the Prevention of Retained Surgical Instruments: What Is the Value of Counting? Annals of Surgery 247.1 (2008): 13-18.
  2. Mehtsun W, MD, MPH, Ibrahim A, MD, Diener-West M, PhD, Pronovost P, MD, PhD, Makary M, MD, MPH, Baltimore, MD, Boston, MA, and Cleveland, OH, 2013 Johns Hopkins report.
  3. Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ, Departments of Surgery, Brigham and Women's Hospital, Boston, MA, Risk factors for retained instruments and sponges after surgery, N Engl J Med. 2003, Jan 16;348(3):229-35.
  4. Stone et al, Am J Infect Control, 2005.
  5. Rupp C, MD, Kagarise M, RN, MSPH, Meyer A, MD, PhD, Kim HJ, MD, Effectiveness of a Radiofrequency Detection System as an Adjunct to Manual Counting Protocols for Tracking Surgical Sponges: A Prospective Trial of 2,285 Patients, University of North Carolina at Chapel Hill School of Medicine, Jour Am Coll Surg, Vol 215, Issue 4, Pages 524–533, October 2012.
  6. Macario A, What does one minute of operating room time cost? J Clin Anesth, 2010, Jun;22(4):233-6.
  7. Williams TL, Tung DK, Steelman VM, Chang PK, Szekendi MK, Retained Surgical Sponges: Findings from Incident Reports and a Cost-Benefit Analysis of Radiofrequency Technology, Journal of the American College of Surgeons, 2014, doi: 10.1016/j.jamcollsurg.2014.03.052.
  8. Dossett et al, Surgery, 2008.
  9. CMS-1390-P, 2008, Average Unreimbursed RSI Procedural Cost Reported by CMS, updated to reflect 2013 dollars.
  10. www.citizens.org, 2012, National Practitioner Data Bank, 2012, Tables 1-6
  11. J Law, Medicine & Ethics, 2012.
  12. Steelman V, PhD, RN, CNOR, FAAN, Cullen J, MD, AORN J 94 (August 2011) 132-141. AORN, Inc. 2011. doi: 10.1016/j.aorn.2010.09.034.