PC28. Retrospective Analysis of Plastic Reconstructive Surgery Incidence of Retained Surgical Items as Confirmed on X-rays

Abstract

PURPOSE: In the event of missing surgical counts, obtaining x-rays to rule out retained surgical items (RSI) is a standard practice. However, these additional safety measures come with risks. This study investigated the incidence of actual RSI on plastic reconstructive surgery (PRS) intra-operative x-rays and its associated modifiable risk factors METHODS: X-rays with indication of “foreign body” in PRS procedures from 2012 to 2022 were obtained. Reports with “incorrect surgical counts” and associated peri-operative records were retrospectively analyzed to determine the incidence of RSI. RESULTS: Among 257 x-rays, 55 (21.4%) indicated incorrect counts during PRS operations. None were positive for RSIs. The average number of staff (physicians, nurses and technicians) present was 12.01. This correlated to an average of 6.98 staff turnovers. The average case lasted 8.7 hours. X-rays prolonged the time under anesthesia by an average of 24.3 minutes (p < 0.0001). Free flap surgeries had 70.9% prevalence of missing counts (lower extremity 43%, breast 27%), followed by craniofacial (12.7%), hand (12.7%), breast reductions (3.6%), and lipo-abdominoplasty (3.6%). CONCLUSION: While x-rays for missing counts intend to prevent catastrophic sequela of inadvertent RSIs, study results suggest the true incidence of RSI in PRS is negligible. However, intra-operative x-rays have potentially harmful and pervasive consequences for patients including increased anesthesia time, radiation exposure, and overall cost. Case complexity, duration and staff turnover appear to correlate with incorrect counts. Therefore, addressing modifiable risk factors to minimize unnecessary intra-operative x-rays is imperative.