Retained Surgical ObjectsWhat are retained surgical objects and how can they be avoided?
Despite strict counting protocols, surgical sponges are unintentionally left inside patients after wound closure. These retained foreign objects (RFO's) are a potential source of morbidity for patients and a liability for care providers and institutions. They result in costly re-operative expenses, legal battles and a compromised hospital reputation. A retained surgical object is a "never event"; something that should never happen, but does.
Retained surgical objects are also known as:
- Unintended Retained Item (URI)
- Retained Foreign Objects (RFO)
- Sentinel Event
62% of retained surgical items were detected after the surgical count was reported as correct (Cima 2008) and it can happen in 1 in every 7,000 cases(1), according to existing surgical literature.
- 76%-88% of all retained surgical objects involve falsely correct sponge counts
- 10%-15% of all retained objects involved having an X-ray
- Sponge counts do not match in 10% of major cases resulting in recounts and verifications
- Mortality related to RFO's ranges from 11% to 35%(2)
(1) Egorova, PhD, Natalia N., Alan Moskowitz, MD, Annetine Gelijns, PhD, Alan Weinberg, MS, James Curty, BS, Barbara Rabin-Fastman, MS, Harold Kaplan, MD, Mary Cooper, MD, Dennis Fowler, MD, Jean C. Emond, MD, and Giampaolo Greco, PhD. "Managing the Prevention of Retained Surgical Instruments: What Is the Value of Counting?" Annals of Surgery 247.1 (2008): 13-18. Print.
(2) Lauwers PR, Van Hee RH. Intraperitoneal Gossypibomas: the need to count sponges. World J Surg 2000; 24: 521-527.
- JCAHO requires hospitals to report all retained objects
- Centers for Medicare and Medicaid Services no longer reimburse for preventable surgical mistakes
- X-Rays do not provide definitive proof against sponge retention
- Despite strict AORN recommendations, surgical sponges are still unintentionally left behind in patients
- Cases involving retained surgical objects result in costly re-operative expenses, legal battles and a compromised hospital reputation
Effective July 15, 2010, the AORN Recommended Practices Committee released the revised Recommended Practices (RP) for the Prevention of Retained Surgical Items, including Recommendation VII which recognizes that Perioperative Staff Members may consider use of adjunct technologies such as RF Detection to supplement manual count procedures. RF Detection Technology can help eliminate the risk of having a retained surgical sponge and improve patient safety while not disrupting operating room workflow.