Retained Surgical Items Often the Result of Medical Malpractice

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As medical malpractice lawyers we are amazed that the incidence of surgical items mistakenly left inside patients has remained steady over the years. In fact, UpToDate estimates that retained surgical items occur in 1 in every 5500 to 18,760 inpatient operations, but may be as high as 1 of every 1000 to 1500 abdominal cavity operations, and even more common during emergency surgery. This persistent medical complication happens across the country and here in Pittsburgh, Pennsylvania. When a surgical instrument or sponge is mistakenly left inside a patient after surgery, medical malpractice is inevitably the cause. reports that 4,500 to 6,000 times a year. While images of X-rays showing retained scalpels, scissors and clamps often come to mind first – it is the simple surgical sponge, which includes both laparotomy pads and smaller sponges that causes patients the most problems. Reports demonstrate that surgical sponges account for 70% of all retained surgical items left behind in patients. This is remarkable since all sponges include a radiopaque string which ensures identification by x-ray. Medical professionals believe that sponges are left behind so often because of the frequency with which they are used, their small size, and because they can blend into surrounding tissues unlike metal instruments.

Though seemingly benign, surgical sponges pose a great danger to patients and can lead to granuloma, obstruction, severe infections and death. Additionally, once discovered, retained items must be removed which places the patient at the additional risks associated with any surgery.

Because of the risk and danger posed by retained surgical items, healthcare practitioners have, for a long time, implemented standardized count protocols to make sure nothing is left behind. Standardized count protocols are the most important step doctors can take to prevent patients from having surgical items trapped inside their bodies after surgery. Doctors and nurses should always count the instruments and sponges used in every surgical procedure. Also, because they do not otherwise show up on x-ray, all sponges should contain radiopaque indicators.

Of interest to all patients about to undergo surgery is the updated recommended practices policy published by the Association of Operating Room Nurses in 2015. This practice policy is widely used and nationally recognized as the gold standard for counting policies in the United States.

UpToDate outlines this gold standard procedure as follows: counts of “soft goods” (i.e. sponges) are performed at the following points during the procedure:

  1. Before the procedure begins (initial count)
  2. Whenever new items are added to the sterile field
  3. Before closure of a cavity within a cavity (ie, the uterus)
  4. When wound closure begins
  5. At skin closure or end of the procedure (final count)
  6. At the time of permanent relief of either the scrub nurse or circulating nurse

The guidelines require that sponges be separated, audibly counted, and concurrently viewed during the count procedure by two individuals, typically the scrub nurse and circulating nurse. If a discrepancy in any of the counts is identified, the guidelines say that the entire surgical team is responsible for carrying out appropriate steps to locate the missing item. UpToDate has determined that the odds of a retained foreign body are increased 100-fold if there is a persistent discrepancy between the initial and final sponge counts . The next requirement is that if the item cannot be found with manual exploration of the surgical site by the surgeon or cannot be located elsewhere in the room, an x-ray must be taken before the patient’s body cavity is closed. Next, before anesthesia is reversed, the radiologist must communicate the results of the x-ray to the surgeon.

Because of the post-surgical retained items are so preventable, the National Quality Forum has listed retained surgical items as a “completely preventable error” that should never happen. This type of medical mistake has been dubbed a “never event.” Furthermore, retained surgical materials have been deemed “always wrong” by the Leapfrog initiative. In the event a medical device is left in a patient, Leapfrog advises that the event must be acknowledged by the doctors with a direct apology to the patient, and hospital payment for all costs incurred as a result.

In 2005, the Joint Commission, the entity that accredits hospitals as eligible for Medicare payments, designated retained surgical items as sentinel events requiring immediate investigation and response. Since 2008, the Centers for Medicare and Medicaid Services deny reimbursement to hospitals for the costs associated with objects left in patients during an operation. Thus, if a hospital and its medical staff cause a device to be left in a patient, it is fraud for them to charge the patient for the care related there.

Despite the standardized count protocol that doctors and health care workers must employ during surgery – surgical items are still being left inside patients. This is often due to a failure to follow every step of the protocol or simply a decision not to utilize the counting system every surgery.

The medical malpractice lawyers of Lupetin & Unatin know that devastating consequences patients experience when surgical instruments and sponges are left inside them after surgery. After such events, patients, their friends and families want answers about how it happened and what can be done to make things right. We make a pledge to all the patients we help to provide the answers and solutions you deserve.

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