The routine count of sponges and instruments used and retrieved during surgery comes up with a discrepancy in one in eight operations, investigators report. However, almost always the missing items are found before any harm is done.
The study shows the value of the so-called "surgical count," say the researchers. They explain that it's estimated that surgical items are actually left in patients' bodies in one in every 5 000 surgeries.
The standard way to prevent such accidents is for the surgery team to count and document all instruments before and during surgery, and again before the surgeon closes the incision.
However, most incidents in which an instrument is left behind occur when the team mistakenly believes it has accounted for all surgery tools, so some surgeons consider the system unreliable - and they sometimes ignore discrepancies in the instrument count.
How the study was done
In the new study, published in the Annals of Surgery, researchers observed 148 operations at one large medical center that uses a standard protocol for counting surgical instruments.
They found that count discrepancies occurred in 19 of the operations. In 59% of these cases, the discrepancy detected a misplaced sponge, needle or other instrument, according to the researchers, led by Dr Caprice C. Greenberg of Brigham & Women's Hospital in Boston.
In 3% of the discrepancies, a surgery team member had incorrectly counted the instruments, while 38% involved an error in documenting the count.
The fact that most of the discrepancies were real underscores the point that surgeons should take these situations seriously, according to Greenberg's team.
"Despite the recognised limitations of manual surgical counts," the researchers write, "discrepancies should always prompt a thorough search and reconciliation process and never be ignored."
The old-fashioned counting method could, however, be improved upon, the researchers note, pointing out that "technological solutions" are being studied. One example is sponges tagged with radiofrequency ID chips that could allow surgeons to detect any left-behind sponges by waving a wand over the patient's body. – (Reuters Health, October 2008)
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