Sponge Counts Research Articles

307 Intraluminal Migration of Gossypiboma and rectal expulsion an unusual Case- Case Report

Abstract Background Gossypiboma refers to foreign body retained in the body at the end of operation and can be in the form of gauze, sponge or any form of textile resulting in grave consequences for both the patient and the surgeon. Case Summary A 23-year-old female presented with complain of generalized abdominal pain along with non-bilious vomiting since 10 days. She also had relative constipation since four days. Her past surgical history was unremarkable except for three elective lower segment caesarean sections at another hospital. Upon abdominal examination, she had a scar of pfannenstiel incision along with 3x4 cm swelling in umbilical region with positive cough impulse. Her bowel sounds were exaggerated. DRE was unyielding. Clinical diagnosis of subacute intestinal obstruction was made and she was managed conservatively. Ultrasound abdomen showed dilated gut loops with hyperperistalsis. It also revealed a defect measuring 8.5 cm in the supraumbilical region of anterior abdominal wall through which fat content was seen protruding. She was advised contrast enhanced CT abdomen, developed diarrhoea and later on expelled the surgical sponge per rectally. After passage of surgical sponge, condition of patient improved and symptoms resolved. Discussion Diligent efforts are required to prevent this human error by ensuring meticulous sponge count, use of radio-opaque sponges, adjunctive use of WHO safety checklist and introduction of new advancements like tagging system in our healthcare system. Conclusion Gossypiboma is under-reported due to reluctance of institutions to report it to governing body. Reporting of such dreadful complications of surgery and analysis of their root cause should be done to prevent such events from happening.

Unintentionally retained foreign objects (URFOs): Adverse events influenced by the pandemic. A case series and literature review

Despite being recognized as a preventable serious adverse event more than a century ago, Unintentionally Retained Foreign Objects (URFOs) continue to occur. They, in fact, remain the second most common Sentinel Event (SE) reported to The Joint Commission (TJC). A large private Hospital, after many years of URFO-free practice, experienced four (4) cases of URFOs during a 12-month period (March 9, 2021–March 4, 2022). Three cases occurred in the Operating Room (OR), and one case occurred in Labor & Delivery. All four cases involved the abdomen. The URFO was a sponge in two cases, a retractor wrapped in a pad in one case, and a surgical specimen in one case. Our review confirmed that the characteristics of our cases were similar to those reported by the Joint Commission. The main contributing factor was the closure of the wound without performing the sponge/instrument count. This safety breach resulted from a combination of factors: the inexperience of the nursing staff caused by a dramatic 40% turnover during the pandemic, the lack of assigned responsibility to perform the counting, and the willingness of the surgeon to skip the count. To address the main factors, we implemented a multipronged approach that includes the following: standardization of the protocols of sponge counting, hand-off with shift change, and of double surgical team involvement; assignment of the counting responsibility to two nurses; and education of the new nurses and of independent practitioners about the OR procedures with monitoring of correct implementation.

Surgical safety checklist compliance: The clinical audit

IntroductionThe surgical safety checklist consists of three components: sign-in, performed before the induction of anesthesia; time-out, performed before skin incision; and sign-out, performed immediately after skin closure or before the patient leaves the operating theatre. This study aims to assess compliance with the World Health Organization (WHO) Surgical Safety Checklist (SSC) and explore the barriers facing in properly implementing the surgical safety checklist in operation theatres of a tertiary care hospital. MethodologyThe observational clinical audit was conducted in Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan. Compliance with the surgical safety checklist was observed before and after the educational intervention. After completion of the clinical audit operating theatre staff was asked about the barriers to compliance with the surgical safety checklist using an interview sheet. Mean, and standard deviation was calculated for quantitative variables, whereas frequencies and percentages were calculated for categorical variables using SPSS version 25.0. ResultsCompliance with all the steps of the surgical safety checklist was improved after an educational intervention, with the highest improvement in compliance (66.7%) observed with the Sign-out step “Count of sponges and needles & instruments complete?” Moreover, filling of the patient board and documentation of procedure in the patient file were also improved. Lack of awareness and training to follow the surgical safety checklist was the commonest barrier to compliance with the surgical safety checklist. ConclusionImplementing the surgical safety checklist will not only upgrade the patient safety measures but also integrate teamwork skills and improve the local departmental culture.

Is the Systematic Sponge Count an Impediment to Patient Care During Plastic Surgical Procedures?

Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.

Gossypiboma as a Rare Cause of Small Bowel Obstruction: A Case Report

Unintentionally retained textile foreign bodies in the abdomen after laparotomy is a serious medical error, with unknown incidence which can lead to severe complications. We present the case of a 24-year-old woman with a retained surgical sponge migrated into the jejunal lumen and causing an intestinal obstruction. Removal of the foreign body required repeated laparotomy and segmental resection of the affected intestinal loop. The article provides the analysis of the imaging diagnostic results, as well as possible reasons that led to the foreign body being left unintentionally. Reliable reduction of incidence and severity of consequences after retention of textile surgical objects in the abdomen can only be achieved through improved standards of patient safety, including careful sponge counting and the routine use of materials with radiopaque markers.

Preoperative Oral Administration of Yunnan Baiyao and Its Effect on Coagulation Parameters in Tick-Borne Disease and/or Heartworm Seropositive Dogs: A Pilot Study

The overall goal of this clinically focused pilot study was to investigate the preoperative benefit of oral administration of Yunnan Baiyao (YB) to Ehrlichia. canis, Anaplasma platys and/or heartworm seropositive canines. A total of 12 clinically normal dogs undergoing sterilization procedures were randomly subdivided into Control/Placebo Group (n=6) or Treatment Group (n=6). Each patient received three oral doses of YB (0.5g/5kg) or placebo every twelve hours with the last dose given the evening before surgery. Citrated blood measurements for prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen were obtained before the first YB dose and after the third dose. Intraoperative blood loss was estimated by blood-soaked gauze sponge counts. The study found the Control Group’s mean aPTT increased by 3.8% while the Treatment Group’s decreased by 0.42%. PT values were slightly decreased in both groups. Fibrinogen decreased in controls (9.7%) but had a modest increase in treated dogs (12.4%). Intraoperative blood loss was increased in controls (3%) compared to the Treatment Group (mean±SD: 6.6±6.8 vs. 6.4±3.6, respectively). Findings from the study which suggest preoperative benefits from YB administration to seropositive dogs include stabilizing aPTT and fibrinogen values along with reduced intraoperative blood loss in YB treated dogs. Although these modest findings were not statistically significant in this small study, the biological trends suggest potential benefits of preoperative administration of YB before routine elective surgeries in seropositive patients and support a clinical trial with larger sample size.

To Err is Human, To Forget is Device-related: A Cautionary Note for Endoscopists

Background: In the United States, ∼5 million endoscopies are performed annually. Contaminated endoscopes account for more nosocomial infections than any other medical device, but the vast majority of such events go unreported. We found no reports in the literature or the FDA Manufacturer and User Facility Device Experience (MAUDE) database of the incident described below. Methods: During a colonoscopy, the operator noticed resistance while advancing a clipping wire through the channel. A balloon-tipped catheter sheath was then extruded into the colonic lumen. The sheath and endoscope were withdrawn without incident, and the procedure was completed with a different endoscope. According to equipment logs, the last time that type of balloon-tipped catheter was used occurred 20 days prior, resulting in 20 patients having potentially been exposed to an incompletely disinfected device. Interrogation of the endoscope with various inserts revealed that the presence of a retained sheath would allow passage of all types of guide wires, (snips, snares, etc), including the cleaning brush. The only device whose passage would have been prevented by a retained sheath was a vascular clipping device. A review of procedure notes and interviews of involved physicians revealed that such clippings were performed as recently as 2 days prior to the incident, thus reducing the number of potentially exposed to 2, plus the index. The county and state health departments were notified, a MAUDE report was filed, and patients were notified and offered free testing for bloodborne and enteric pathogens. Discussion: The root causes of the exposure included the absence of a closed-loop feedback for removable components (similar to an operating room sponge count), an inexperienced endoscopy technologist, and, in our opinion, a design flaw of the sheath that allows the sheath to enter the channel. Specifically, unlike other sheath brands, this brand lacks a large, irremovable warning flag that precludes channel entry (Fig. 1). Had we not been able to trace the use of each individual endoscope (n = 45) in the clinic and link each to specific patients, procedures, and reprocessing logs, we would have had no way to determine the extent of exposures. This incident, which we present as a cautionary tail to others, highlights (1) a possible equipment design flaw, (2) the importance of closed-loop feedbacks for removable components, (3) the criticality of detailed procedure notes along with granular cleaning and reprocessing logs traceable to every endoscope, and (4) the challenge of communicating risk of disease transmission to patients.Funding: NoneDisclosures: None

Development of a Surgical Sponge Counting System Using Radiographic Images.

Background. Retention of surgical sponges in patients is a relatively frequent medical malpractice. To prevent it, the surgical sites are scanned using X-ray. However, using radiography in the operation room induces X-ray exposure for both patients and staff. To prevent such issues, a novel sponge counting system was developed. Each surgical sponge used in common hospitals is composed of single radiopaque fibers. Methods. The proposed system scans surgical sponges to estimate their fiber length (EFL) and returns the number of it. In this study, an optimal image acquisition protocol was determined that allows an accurate count of sponges. X-ray doses and multi-angle image procedures were tested. Results. Measurement trials were performed and compared for both dry and blood-soaked sponges. As a result, the X-ray dose of 50 kV and 600 μA and the acquisition of 180 images per sample yielded an accurate EFL. The 180-image protocol achieved good performance in this study and allowed counting of one package of 10 sponges in 226 seconds. For these settings, a significant correlation was found between the actual number of sponges and the estimated fiber lengths. Additionally, the performance of the system was similar for either dry or blood-soaked items. Conclusion. The proposed system could accurately count surgical sponges and is a promising option in preventing the accidental retention of surgical sponges.

Implementing a "visualize and verify" process for the surgical sponge count.

AORN JournalVolume 111, Issue 2 p. P11-P13 AORN Periop Briefing Implementing a “visualize and verify” process for the surgical sponge count First published: 29 January 2020 https://doi.org/10.1002/aorn.12971Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume111, Issue2February 2020Pages P11-P13 RelatedInformation

The Effect of Radiofrequency Technology on Time Spent Searching for Surgical Sponges and Associated Costs

Retained surgical items (eg, sponges, instruments) remain the most frequently reported sentinel events. The primary strategy for preventing retained sponges is the sponge count. Reconciling sponge counts is time consuming and can extend the duration of operative and other invasive procedures. The primary objective of this observational study was to evaluate the effect of a radiofrequency (RF) surgical-sponge detection system on time spent searching for surgical sponges. The study included 27,637 procedures during nine months before and after implementing an RF surgical-sponge detection system. After implementation of the system, time spent searching for sponges was reduced by 79.58%, the percentage of unreconciled counts was reduced by 71.28%, and time spent using radiography to rule out a retained sponge was reduced by 46.31%. This resulted in a reduction of costs. These findings should be used as part of a comprehensive cost analysis of alternative methods when evaluating RF sponge detection technology.

Evaluation of factors associated with retained surgical sponges in veterinary patients: a survey of veterinary practitioners.

To evaluate factors that could be associated with retained surgical sponges in veterinary patients. A survey was distributed to 322 veterinarians attending a national veterinary conference in the UK. The survey included questions about the staff, scheduling, type of surgical procedure, surgical sponges, methods to track surgical sponges and details of clinical cases with retained surgical sponges. The response rate was 64 of 322 (19%). Lack of designated scheduled time for surgical procedures was reported by 30% of respondents and was variable for 31%. More than half of respondents (66%) had two people involved in each surgical procedure. The majority of respondents sterilised their own surgical sponges (91%) and used non-radiopaque surgical sponges (56%). Sponges were not counted by 27% of respondents and only occasionally by 20%. Sponge count was not recorded by 70% of respondents. The majority (66%) did not use or have a surgical checklist. Lack of awareness of gossypibomas was reported by 11% of respondents. In all, 27% of respondents were aware of at least one case of retained surgical sponge. Of the 17 cases reported, 14 were small animals. The abdomen was the most common anatomical location for retained surgical sponges and followed elective neutering. Despite the low-response rate, our results suggest that methods of surveillance might reduce the incidence of retained surgical sponges. Lack of specifically scheduled time for surgery, few theatre staff and lack of sponge counting and documentation may have contributed to the 17 retained surgical sponge cases reported.

Retained surgical sponges: a descriptive study of 319 occurrences and contributing factors from 2012 to 2017

BackgroundUnintended retention of foreign bodies remain the most frequently reported sentinel events. Surgical sponges account for the majority of these retained items. The purpose of this study was to describe reports of unintentionally retained surgical sponges (RSS): the types of sponges, anatomic locations, accuracy of sponge counts, contributing factors, and harm, in order to make recommendations to improve perioperative safety.MethodsA retrospective review was undertaken of unintentionally RSS voluntarily reported to The Joint Commission Sentinel Event Database by healthcare facilities over a 5-year period (October 1, 2012- September 30, 2017). Event reports involving surgical sponges were reviewed for patients undergoing surgery, invasive procedures, or child birth.ResultsA total of 319 events involving RSS were reported. Sponges were most frequently retained in the abdomen or pelvis (50.2%) and the vagina (23.9%). Events occurred in the Operating Room (64.1%), Labor and Delivery (32.7%) and other procedural areas (3.3%). Of the events reported, 318 involved 1 to 12 contributing factors totaling 1430 in 13 different categories, most frequently in human factors and leadership. In 69.6% of reports, the harm was an unexpected additional care or extended stay. Severe temporary harm was associated with 14.7% of the events. One patient died as a result of the retained sponge.ConclusionsBecause of the complexity of perioperative patient care, the multitude of contributing factors that are difficult to control, and the potential benefit of radiofrequency sponge detection, we recommend that this technology be considered in areas where surgery is performed and in Labor and Delivery.

Incidence, root cause, and outcomes of unintentionally retained intraabdominal surgical sponges: a retrospective case series from two hospitals in Togo

BackgroundThe term gossypiboma refers to a sponge that has been forgotten in the surgical field. It is the most common retained surgical item, and constitutes a continuing problem for surgical safety. We performed a hospital-based study to examine their incidence, root cause, and outcomes, as an effort toward improving prevention.MethodsThis retrospective study covered 10 years (2006-2015) and included surgically confirmed cases of abdominal gossypibomas occurring after 45,011 abdominal and gynaecological operations in 2 public hospitals in Lome (Togo). Age, diagnosis, initial surgical procedure, evidence of textile count, and data related to the revision procedure were collected for descriptive analysis.ResultsFifteen cases of gossypibomas (11 women and 4 men) were recorded. The mean age of the patients was 27 (range 21-55) years. Initial procedures were gynaecological in 11 patients and 5 cases involved an emergency surgery. Evidence of sponge counting was found in 6cases. Gossypiboma was an incidental finding in 1 patient. The average time to onset of symptoms after the initial procedure was 2 months. The gossypiboma was removed within 7 days to 4 years after the initial procedure. Postoperative complications included enterocutaneous fistula in 2 patients, incisional hernia in 2 patients, and wound sepsis in 1 patient. Death occurred in 2 patients (13.3%).ConclusionsAlthough rare, the incidence of gossypibomas is still unacceptably high and reveals failures regarding patient safety standards. The associated morbidity and mortality are significant, yet can be reduced by an early diagnosis in the immediate postoperative period. A systematic methodical count of sponges is the cornerstone of prevention, and introducing surgical safety protocols, such as the WHO Safe Surgery Saves Lives checklist, can enhance effectiveness. There is a crucial need for safety-focused policies, which may include a never event reporting system, elaboration of prevention strategies, interventions, and evaluation.

Using the WHO Surgical Safety Checklist to Direct Perioperative Quality Improvement at a Surgical Hospital in Cambodia: The Importance of Objective Confirmation of Process Completion

BackgroundThe WHO surgical safety checklist (SSC) is known to prevent postoperative complications; however, strategies for effective implementation are unclear. In addition to cultural and organizational barriers faced by high-income countries, resource-constrained settings face scarcity of durable and consumable goods. We used the SSC to better understand barriers to improvement at a trauma hospital in Battambang, Cambodia.MethodsWe introduced the SSC and trained data collectors to observe surgical staff performing the checklist. Members of the research team observed cases and data collection. After 3 months, we modified the data collection tool to focus on infection prevention and elicit more accurate responses.ResultsOver 16 months we recorded data on 695 operations (304 cases using the first tool and 391 cases with the modified tool). The first tool identified five items as being in high compliance, which were then excluded from further assessment. Two items—instrument sterility confirmation and sponge counting—were identified as being misinterpreted by the data collectors’ tool. These items were reworded to capture objective assessment of task completion. Confirmation of instrument sterility was initially never performed but rectified to >95% compliance; sponge counting and prophylactic antibiotic administration were consistently underperformed.ConclusionsStaff complied with communication elements of the SSC and quickly adopted process improvements. The wording of our data collection tool affected interpretation of compliance with standards. Material resources are not the primary barrier to checklist implementation in this setting, and future work should focus on clarification of protocols and objective confirmation of tasks.

Radiofrequency-Based Identification Medical Device: An Evaluable Solution for Surgical Sponge Retrieval?

A retained surgical item in patients (gossypiboma) is a persisting problem, despite consistent improvements and existing guidelines in counting instruments and sponges. Previous experiences with radiofrequency identification technology (RFID) tracking sponges show that it could represent an innovation, in order to reduce the criticism and increase the effectiveness during surgical procedures. We present an automated system that allows reduction of errors and improves safety in the operating room. The system consists of 3 antennas, surgical sponges containing RFID tags, and dedicated software applications, with Wi-Fi real-time communication between devices. The first antenna provides the initial count of gauzes; the second a real-time counting during surgery, including the sponges thrown into the kick-bucket; and the third can be used in the event of uneven sponge count. The software allows management at all stages of the process. In vitro and in vivo tests were performed: the system provided excellent results in detecting sponges in patients' body. Hundred percent retained sponges were detected correctly, even when they were overlapped. No false positive or false negative was recorded. The counting procedure turned out to be more streamlined and efficient and it could save time in a standard procedure. The RFID system for sponge tracking was shown to be experimentally a reliable and feasible method to track sponges with a full detection accuracy in the operating room. The results indicate the system to be safe and effective with acceptable cost-effective parameters.

Gossypibomas in India - A systematic literature review.

Purpose of Review:Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature.Materials and Methods:A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India.Results:On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%).Conclusions:Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.

The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery.

To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery. Emergency surgery patients are at high risk for retained foreign bodies. All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed. In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8. Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.

The World Health Organization Surgical Safety Checklist Improves Post-Operative Outcomes: A Meta-Analysis and Systematic Review

Background: The incidence of in-hospital adverse events is about 10%, with a majority of these related to surgery, and nearly half considered preventable events. In attempts to improve patient safety, the World Health Organization (WHO) developed a checklist to be used at critical perioperative moments. This meta-analysis examines the impact of the WHO surgical safety checklist (SSC) on various patient outcomes. Methods: A comprehensive search of all published studies assessing the use of the WHO SSC in patients undergoing surgery was conducted. Studies using the WHO SSC in any surgical setting, with pre-implementation and post-implementation outcome data were included. The incidence of patient outcomes (total complications, surgical site infections, unplanned return to the operating room (OR) within 30 days, and overall mortality) and adherence to safety measures were analyzed. Results: 10 studies involving 51,125 patients (27,490 prior to implementation and 23,635 after implementation of the WHO SSC) were analyzed. The implementation of the WHO SSC significantly reduced the risk of total complications by 37.9%, surgical site infections by 45.5%, unplanned return to OR by 32.1%, and mortality by 15.3%. Increased adherence to safety measures including airway evaluation, use of pulse oximetry, prophylactic antibiotics when necessary, confirmation of patient name and surgical site, and sponge count was also observed. Conclusions: The use of the WHO SSC is associated with a significant reduction in post-operative complication rates and mortality. The WHO SSC is a valuable tool that should be universally implemented in all surgical centers and utilized in all surgical patients.

Retained Post-Operative Foreign Body of Gynaecologic Origin at Ascending Colon

Post-operative retention of surgical sponges occurs in 1 in 5,500 cases. Migration from the abdomen to the intestines occurs infrequently. The incidence is unknown due to poor reporting. A 38 year old nullipara presented with a four month history of increasingly painful abdominal swelling following myomectomy. She had a history of low grade fever, nausea and constipation. On examination, she was afabrile, in mild/moderate distress and chronically ill-looking. Abdominal examination showed an 8 cm × 6 cm firm, mobile and tender, right sided para-umbilical mass with a discharging sinus along the lower 1/3 of the midline sub umbilical surgical wound. Ultrasound suggested an abdominal-pelvic abscess. Exploratory laparotomy revealed severe fibrinoid adhesions involving the fundus of the uterus, sigmoid colon, ascending colon and anterior abdominal wall. Dissection revealed that two pieces of sanitary pads in the ascending colon formed the right sided para-umbilical mass palpated on abdominal examination. There were bowel perforations involving the illeocecal complex and ascending colon. The ovaries and fallopian tubes were not visualized. The sanitary pads were removed; right hemicolectomy, ileocolic anastomosis and copious abdominal lavage were performed. By two weeks after surgery she developed an enterocutenous fistula (ECF) that healed spontaneously within two weeks. Meticulous surgical techniques including surgical sponge and instrument counts and intracavity sponge tagging should be observed while working in body cavities.

The Hidden Costs of Reconciling Surgical Sponge Counts

Retained surgical sponges are serious adverse events that can result in negative patient outcomes. The primary method of prevention is the sponge count. Searching for sponges to reconcile counts can result in inefficient use of OR time. The purpose of this descriptive study was to estimate the cost of nonproductive OR time (ie, time spent not moving forward with the surgical procedure) spent reconciling surgical sponge counts and the cost of using radiography to rule out the presence of retained sponges. We included 13,322 patient surgeries during a nine-month period. Perioperative personnel required from one to 90 minutes of additional time to reconcile each of 212 incorrect/unresolved counts. The total annualized cost of OR time spent searching for sponges and ruling out the presence of potentially retained sponges using radiography was $219,056. These costs should be included in comprehensive cost analyses when considering alternatives to supplement the surgical count.