Medical errors during surgery vary widely, and one of the most serious is leaving surgical instruments, such as sponges, scalpels, or needles, inside a patient’s body. While rare, this mistake can have severe and even life-threatening consequences. In this article, we’ll discuss the risks associated with retained surgical instruments and explore strategies to prevent these errors.

Causes of Retained Surgical Instruments

1. Inaccurate Instrument Counts: The most common reason for retained instruments is an inaccurate count. Surgical tools and materials need to be counted precisely before, during, and after each operation.
2. Communication Gaps in the Surgical Team: Miscommunication or lack of coordination among surgical staff can lead to oversights, such as items being left inside a patient.
3. Inadequate Protocols and Procedures: The absence of standardized protocols for counting and tracking surgical instruments can increase the risk of such incidents.
4. Human Factors: Fatigue, stress, or distraction among surgeons and the surgical team can also contribute to mistakes during procedures.

Symptoms of Retained Surgical Instruments

The presence of a retained surgical item can cause acute symptoms such as inflammation, infection, abscesses, pain, or lumps within days or weeks post-surgery. This risk is higher in procedures involving many instruments, retractors, or surgical sponges. Severe symptoms may require immediate surgery to remove the foreign object.

Detection and Tracking of Retained Instruments

Imaging tests are the primary method for detecting retained items. These objects often appear as masses in the abdominal cavity and can be identified through X-rays or other radiology techniques. If there’s suspicion of malignancy, a CT or MRI scan may be required for further examination.

Common Locations for Retained Instruments

Retained surgical items have been found in various parts of the body, including the nasal cavity, retroperitoneal space, uterus, and spine, but are most often discovered in the abdominal cavity. When left there, they can cause symptoms such as abdominal pain, tumors, abscesses, bowel perforation, fistulas, and bleeding.

Most Common Retained Item

Sponges are the most frequently retained surgical item, often found in the abdomen, pelvis, or retroperitoneal space. They may remain in the body for days, months, or even years before causing an inflammation reaction. Other retained tools can include clamps, retractors, electrodes, or drains.

Preventing

• Effective Team Communication: Clear communication among the surgical team is crucial to minimizing errors during procedures.
• Multi-Step Instrument Counting: Surgical staff, especially the scrub nurse, should count instruments at multiple points during the surgery to ensure nothing is left behind. This should be done at specific times (before the procedure, each time a new item is introduced, before closing the body cavity, when closing the wound, and when closing the skin). Instrument counting can be challenging, especially in emergency surgeries, as the entire team’s focus shifts toward stabilizing the patient.
• Using Advanced Technology: Newer tracking methods, like radio-frequency identification (RFID) chips, offer a highly accurate way to count and locate surgical items, thanks to their unique serial numbers. These systems can save time and costs, potentially improving patient safety by reducing errors. However, RFID tracking for reusable metal instruments is challenging due to the sterilization process they must undergo.

Consequences of Retained Surgical Instruments

• Internal Injury: If a sharp object, such as a scalpel blade, is left inside, it can damage surrounding tissues, causing internal bleeding, fistulas, or obstructions, which may result in pain, additional surgery, and, if untreated, even death.
• Infection: When porous items like sponges are left inside the body, they can harbor bacteria, leading to infections. Without prompt antibiotic treatment, these infections may become life-threatening and, in some cases, lead to severe complications like infertility.
• Need for Additional Surgery: When a retained item is discovered, patients often need a second surgery to remove it. This increases recovery time, incurs extra costs, and can cause significant emotional distress. Patients may also be entitled to seek compensation through medical malpractice claims.

Conclusion

Addressing retained surgical instruments is critical to patient safety and the overall quality of healthcare. By understanding the causes and consequences of these incidents, healthcare professionals can work together to minimize errors and improve surgical procedures. Implementing effective team communication, multi-step instrument counting, and advanced tracking technologies are vital steps in preventing retained surgical items. Continued efforts to refine protocols and adopt new tools will contribute to safer, more successful surgeries and ensure that patients receive the highest level of care.