Posted by Bill Sandweg on 14 September 2020.

There are certain events which are never supposed to happen.  They are called “never” events.  One of them is the foreign object left behind in the body of the surgical patient.  Prior to the adoption of procedures and checklists requiring multiple counts of instruments and sponges, this used to be a more significant problem.  Today, this complication occurs only once in many thousands of surgeries.

A lot of thought has gone into preventing foreign objects from being left behind at surgery.  In the first place, all surgical instruments and sponges are counted before the surgery begins.  They are counted again after the surgery is complete and before the surgical incision is closed.  If the count is incorrect, the surgeon will go looking for the missing object.  If the count is correct, the surgeon will close the incision and send the patient on to the PACU.

Another innovation to prevent this complication is the requirement that all sponges used in surgery be able to be detected by x-ray.  If there is a problem, or sometimes as a matter of routine, post-surgical patients are x-rayed to check for the presence of any sponges or instruments which may have been left behind.  An even more recent innovation is the use of radiofrequency tags on sponges so they can be identified, located and counted by a computer.

Even with the adoption of these procedures and checklists, foreign objects, especially sponges, continue to be left behind at surgery.

According to the studies, no body cavity is safe from a foreign object being left behind but the greatest number are left behind in the abdomen or the thorax.  Over three quarters of the objects left behind are sponges.  The remainder are instruments.

The presence of the object may go undetected for years.  Only rarely are they discovered shortly after the surgery.  They can be quite damaging as well.  Sometimes the object can perforate a body part, such as the bowel.  Serious consequences, including death, can result.

How and why does this happen and what can be done to prevent it?

A number of research studies have tried to identify the risk factors associated with the retention of foreign objects.  Here are some of their findings.

Change in OR nursing team.  Sometimes it is necessary during the course of a surgery to change the nurses in the operating room.  When the nurses who end the procedure and make the final counts are different than the nurses who counted the objects and began the operation, there is a greater risk of a mistake.  Significantly, in the case of most foreign objects, the count at the end of the surgery was correct.

Emergency surgery.  This seems to make sense.  The bigger the hurry the surgical team is in, the greater the likelihood something will be left behind and no one will notice.

Change in procedure.  This one is similar to the emergency surgery.  The team plans a particular surgery but, during the procedure, makes a discovery which requires them to perform a different or additional procedure.  The change may throw things off and such changes are associated with a greater risk of a retained object.

Excessive blood loss.  This is another one which makes sense.  In a very bloody surgery, it is easier to lose track of an instrument or a sponge and not notice that it has been left behind.

Excessive body mass index.  It is easier to lose track of an instrument or sponge if the patient is morbidly obese.

Lengthy surgery.  The longer the surgery, the greater the likelihood the surgical team will become fatigued and make a mistake in counting.

Absence of a count.  In spite of the requirement at all institutions that instruments and sponges be counted at the beginning and end of all procedures, some of the cases of retained objects had no recorded count.  It is unclear whether one was done but not recorded or, perhaps more likely, was overlooked for one reason or another.

Unlike most medical malpractice cases, where there is a fight over whether the health care provider acted within the standard of care or not, cases involving retained foreign objects after surgery are very clear cut and among the easiest for the patient to win.  There is no defense to having left an object behind.  The only question is what were the damages caused by the object.

Fortunately, this is a rare occurrence.  When it does occur, it can cause little injury or the injury can be catastrophic.  If you have been the victim of a retained foreign object, call an experienced malpractice attorney to see what your rights may be.