Preventable Surgical Complications: Retained Surgical Items

Surgeries of all types have a risk for complications. Routine complications can include things such as the body’s refusal of an implanted device, delayed healing, bleeding, wound dehiscence (opening up) or infection. Other complications can be preventable and are indicative of malpractice. One of the most common types of surgical complications that often lead to medical malpractice claims is retained surgical items. This means an item or tool from performing the surgery is left inside the patient’s surgical site unintentionally. Retained items occur in up to 1 per 1000 abdominal operations (Stawicki, et al. 2009). Retained items left behind in surgery is associated with a 2% mortality rate (Grant-Orser, Davies, & Singh, 2012). This leads to injury, death, and costly medical malpractice claims.

Most commonly, the item that is retained is a small item such as a gauze or sponge. Surgical packs, drain tubes and vascular devices make up 68% of retained items (Hibbert, et. al., 2020). Less commonly, a larger item such as an actual instrument will be left behind. These foreign bodies often cause difficulty in the body healing correctly from the surgery that was performed. They can also lead to infections.

When evaluating a medical malpractice case for surgical complications, it is important to look for potential signs of a retained surgical item. Some signs of a retained surgical item are pain or tenderness at the surgical site or infection (Grant-Orser, Davies, & Singh, 2012). It is further important to note any definitive finding of a foreign body, such as identification on radiology imaging or physical removal during a secondary procedure.

The medical community takes steps to prevent retained items to include a thorough item count at the medical time out at the beginning of a surgical procedure, and another count prior to closing the surgical site at the end of the procedure. A legal nurse should pay attention to item count documentation if a retained surgical item is found or suspected. If item count documentation is missing from a medical record, it is key to highlight this omission. Retained drains are commonly missed in the post-operative phase after operative item counts are done, often having a delayed detection up to 6-18 months (Hibbert, et. al., 2020).

The appropriate intervention when a retained item is identified would be to take the patient back to surgery for physical removal of the item. Further, other interventions would include treatment of any secondary complications such as bleeding, delayed healing or infection that was caused by the retained item.
Retained surgical items are a common, yet very preventable surgical complication. This type of complication leads to between 4,000-6,000 malpractice claims a year (Eriksen, 2015). This leads to an estimated average of $60,000 in hospital costs and $200,000 malpractice payouts per case (Eriksen, 2015). It is important that a legal team be able to identify the signs of a retained item, the methods used to prevent a retained item, identification of the retained item, and appropriate secondary management of the retained item complications.

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References:
Eriksen, K. (2015). The Lingering Problem of Retained Surgical Items. Retrieved from https://www.rasmussen.edu/degrees/health-sciences/blog/retained-surgical-items/#:~:text=In%20cases%20of%20retained%20surgical%20items%2C%20the%20average,according%20to%20an%20investigative%20report%20by%20USA%20Today.

Grant-Orser, A., Davies, P., & Singh, S.S. (2012). The lost sponge: Patient safety in the operating room. Canadian Medical Association Journal 184(11): 125-1278.

Hibbert, P.D., Thomas, M. J., Deakin, A., Runciman, W. B., Carson-Stevens, A., & Braithwaite, J. (2020). A qualitative content analysis of retained surgical items: Learning from root cause analysis investigations. Internal Journal for Quality in Health Care, 32 (3).

Stawicki, S.P., Evans, D.C., Cipolla, J., Seamon M. J., Lukaszczyk, J.J.., Prosciak, M.P.., Torigian, D.A., Doraiswamy, V.A., Yazzie, N.P., Gunter, O.L., Steinberg, S.M. (2009). Retained surgical foreign bodies: A comprehensive review of risks and prevention strategies. Scandinavian Journal of Surgery, 98 (1).