Retained objects after surgery

The patient leaves the operating room with a sponge, a clamp, or a towel inside. What is the impact on the patient of a retained object after surgery?

We’ve heard the stories of the patient’s clamp that sets off the metal detector in the airport, but many patients find out about the presence of a retained object as a result of a medical change: infection (the biggest risk affecting nearly 50 percent of patients), a fistula (tunnel between two organs), perforation of an organ, or a bowel obstruction. Most commonly, the patient is readmitted to the hospital and has to undergo surgery to remove the retained object.

How do instruments and sponges get left behind? The highest risk is an emergency surgery – there is a nine-fold risk.

With the focus on the saving the patient’s life, counts of instruments can fall by the wayside. There is a four-fold risk when there is an unplanned change in surgery based on new findings or changes in the patient’s clinical condition.

Obese patients have a higher risk of instruments or sponges being lost in the body. The risk of retained instruments is doubled when more than one surgical team performs surgery at the same time. The risk also increases when there is greater blood loss during the procedure.

There are several patient safety recommendations offered by the American College of Surgeons, The Food and Drug Administration, and the Association of Operating Room Nurses. Recommendations focus on the methods of counting and reconciling discrepancies, the types of sponges used, the need to thoroughly check the wound before closing, and the documentation of counts. The use of surgical sponges embedded with radiofrequency chips makes retained sponges easier to locate.

The Centers for Medicare and Medicaid Services took a stand on this problem by announcing it is no longer providing reimbursement for care necessitated by the retained surgical instruments.

Implications of Retained Objects After Surgery for Attorneys and Legal Nurse Consultants

These are difficult cases to defend – retained instruments and sponges during emergency procedures are the most easily defensible cases. Analysis of damages centers around the effects on the patient from the retained instrument or sponge, which can be considerable.

During discovery, obtain procedures for surgical counts. Determine if an incident report was completed. Get statements or depose healthcare providers in the operating room at the time.

• Were the packages of sponges counted before the surgery to verify the number printed on the outside of the package was correct?
• Did the surgeon dismiss the incorrect count without re-exploring the wound?
• Did the nursing staff accept the incorrect count?
• Was there any sign of breakage of devices after they were removed from the patient?
• Were non-x-ray detectable sponges used?
• Were counts performed in an audible manner?
• When was the count performed in relation to closing the wound?
• Did the radiologist versus the surgeon read the x-ray when the count was incorrect?

Have the expert witnesses carefully evaluate the circumstances in comparison to the reasonably prudent, versus the superior standard of care. For example, while radiofrequency sponges are a wonderful innovation, their use is not the standard of care as of now.

Learn more about operating room nursing liability by watching our webinar, Deciphering Operating Room Nursing Liability.