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Review
. 2013 Mar;95(2):87-92.
doi: 10.1308/003588413X13511609957218.

Retained surgical sponges, needles and instruments

D Hariharan  1 , D N Lobo
Affiliations
Review

Retained surgical sponges, needles and instruments

D Hariharan et al. Ann R Coll Surg Engl. 2013 Mar.

Abstract

Introduction: Retained sponges and instruments (RSI) due to surgery are a recognised medical 'never event' and have catastrophic implications for patients, healthcare professionals and medical care providers. The aim of this review was to elucidate the extent of the problem of RSI and to identify preventative strategies.

Methods: A comprehensive literature search was performed on MEDLINE(®), Embase™, the Science Citation Index and Google™ Scholar for articles published in English between January 2000 and June 2012. Studies outlining the incidence, risk, management and attempts to prevent RSI following surgical intervention were retrieved.

Results: The overall incidence of RSI is low although its incidence is substantially higher in operations performed on open cavities. Sponges are the most commonly retained item when compared with needles and instruments. Clinical presentation is varied, leading to avoidable morbidity, and the error is indefensible medicolegally. Risk factors include emergency operations, operations involving unexpected change in procedure, raised body mass index, and a failure to perform accurate sponge and instrument counts. The existing strategy for prevention is manual counting of sponges and instruments undertaken by surgical personnel. This, however, is fallible. Computer assisted counting of sponges using barcodes and gauze sponges tagged with a radiofrequency identification device aiding manual counting have been trialled recently, with success.

Conclusions: Vigilance among operating theatre personnel is paramount if RSI is to be prevented. Prospective multicentre trials to assess efficacy of new technologies aiding manual counting should be undertaken if this medical error is to be eliminated completely.

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Figures

Figure 1
Figure 1
An obese patient developed a wound infection at the site of an incisional hernia repair performed 10 weeks previously. This was treated in the community with negative pressure wound therapy (NPWT). Foul-smelling discharging pus persisted from a wound sinus after cessation of NPWT. Computed tomography (left) showed an area of inflammation with multiple air pockets (arrow) in the subcutaneous tissue of the anterior abdominal wall. Wound exploration under general anaesthesia revealed a sponge (without a radiopaque marker) used for the NPWT dressings in the subcutaneous fat (right). The sponge was removed, the wound healed by secondary intention and the patient made an uneventful recovery.
Figure 2
Figure 2
Suggested algorithm to prevent retained sponges and instruments
See this image and copyright information in PMC

Comment in

  • Retained surgical sponges, needles and instruments.
    Steelman VM. Steelman VM. Ann R Coll Surg Engl. 2014 Mar;96(2):174-5. doi: 10.1308/rcsann.2014.174. Ann R Coll Surg Engl. 2014. PMID: 24780693 Free PMC article. No abstract available.
  • Authors' response.
    Hariharan D, Lobo DN. Hariharan D, et al. Ann R Coll Surg Engl. 2014 Mar;96(2):175. doi: 10.1308/rcsann.2014.175. Ann R Coll Surg Engl. 2014. PMID: 24895764 Free PMC article. No abstract available.

References

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