Abstract
Objective(s)This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of Australian case law.Design, Setting and ParticipantsWe reviewed Australian cases from 1981 to 2018 to establish a pattern of antecedents and identify long-term patient impacts (human costs) of retained surgical items. We used a modified four-step process to conduct a systematic review of legal doctrine, combined with a narrative synthesis approach to bring the information together for understanding. We searched LexisNexis, AustLII, Coroner Court websites, Australian Health Practitioner Regulation Agency Tribunal Decisions and Panel Hearings, Civil and Administrative Tribunal summaries, and other online sources for publicly available civil cases, medical disciplinary cases, coronial cases, and criminal cases across all Australian jurisdictions.ResultsTen cases met the inclusion criteria, including one coronial case, three civil appeal cases, and six civil first instance cases. Time from item retention to discovery ranged from 12 days to 20 years, with surgical sponges the most frequently retained item. Five case reports indicated possible deviations from standard protocols regarding counting procedures and record-keeping. In the four cases that reported on count status, the count was deemed correct at the end of surgery. Case reports also showed the human costs of retained surgical items, that is, the long-term impacts on patients associated with a retained surgical item. In eight of the nine civil cases, ongoing pain was the most frequently reported physical symptom; in three cases, patients suffered psychosocial symptoms requiring treatment.ConclusionWhile there was little uniformity in the items retained or how items came to be retained, we identified significant time delays between item retention and item discovery, coupled with long-lasting physical and psychosocial harms suffered by patients living with a retained surgical item. Current prevention strategies, including national standards-based professional practices, are not always effective in preventing retained surgical items. An internationally standardised taxonomy and reporting criteria, more consistent reporting, and open access to event and risk data could inform a more accurate global estimate of risk and incidence of this hospital-acquired complication.
Highlights
The total global volume of surgical operations performed in 2012 was estimated at almost 313 million procedures,[1] and the rate is undoubtedly increasing as the Received: 20 April 2021 Accepted: 13 July 2021 Published: 31 August 2021Journal of Multidisciplinary Healthcare 2021:14 2397–2413Powered by TCPDFDovepress burden of disease requiring interventional surgery increases.[2]
The inci dence of in-hospital surgical complication in Australia and New Zealand was reported to be 20% in 2013,4,5 which was higher than the international average
We focus our attention on understanding the risks, antecedents, and human costs of living with a retained surgical item and make recom mendations to improve detection, responses and reporting
Summary
The total global volume of surgical operations performed in 2012 was estimated at almost 313 million procedures,[1] and the rate is undoubtedly increasing as the Received: 20 April 2021 Accepted: 13 July 2021 Published: 31 August 2021Journal of Multidisciplinary Healthcare 2021:14 2397–2413Powered by TCPDF (www.tcpdf.org)Dovepress burden of disease requiring interventional surgery increases.[2]. Surgical complications seem ubiquitous, adverse events, which result in harm to a person receiving care, are potentially preventable. One such adverse event is when a surgical item is unintentionally left behind in the patient after surgery, known as a retained surgical item (RSI). Large semi nal trials estimate that manual counting procedures are only 77% effective in picking up an RSI17 and intraopera tive x-rays are only 67% effective in picking up RSIs.[18] in 62–88% of RSI cases, the count at the end of the procedure was reported as correct.[10,18,19] In the past decade, several adjunctive technologies have been incorporated into prevention strategies, such as radio fre quency identification (RFID), bar coding of surgical items or other automated counting technologies;[20,21,22] none of these newer technologies are used consistently across jurisdictions or facilities
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