Surgical Counts Research Articles

Trauma: When There's No Time to Count

Trauma is the leading cause of death for people younger than age 45 in the United States. To help prevent death or disability, critically injured trauma patients must reach definitive care within the "golden hour."Often, the perioperative team has no more than 10 minutes to prepare the room before a patient who has suffered multiple, critical, traumatic injuries is rushed into the OR. For the trauma patient's safety, the perioperative team must be diligent and use creative measures to efficiently ensure that all surgical counts are completed. Foregoing surgical counts places the trauma patient at an increased risk for unintentionally retained foreign objects.

Performing Surgical Counts

AORN JournalVolume 87, Issue 2 p. 329-332 Clinical Performing Surgical Counts First published: 06 February 2008 https://doi.org/10.1016/j.aorn.2008.01.009 The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as potential conflicts of interest in publishing this article. This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements. AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure. Read 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 onFacebookTwitterLinked InRedditWechat Volume87, Issue2February 2008Pages 329-332 RelatedInformation

Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients

We presented 23 patients with necrotizing fasciitis (NF), 15 of whom had uncontrolled diabetes mellitus (DM), for risk factors, clinical signs, laboratory findings and prognosis during the period 1998 and 2006 in Istanbul. A hospital incidence of NF was 14.2/100,000 admissions. Other risk factors were obesity in 9 and recent surgical trauma in 10 patients. The mean age of the patients with DM was higher than that of the patients with non-DM (58.6 ± 12.8 vs 43.0 ± 17.2 years, p = 0.028). The most frequently isolated microorganisms from tissue cultures were Escherichia coli, Klebsiella pneumoniae and Group A streptococci. Of the 23 patients, 9 (39%), of whom 8 had DM, died between 2 and 29 days after admission. The mortality rate and length of hospitalization were longer in diabetic patients than in others ( p = 0.02 and p = 0.286, respectively). The mean blood glucose levels and HbA1C were higher in non-survival group than in survival group (195.6 ± 41.5 vs 133.7 ± 22.1 and 10.6 vs 7.4) ( p = 0.04, r = 0.39 and p = 0.03, r = 0.50, respectively). In the univariate analysis, the hospitalization time ( r = 0.72), white blood cell count ( r = 0.52) and surgical debridement count ( r = 0.47) were found to be prognostic risk factors. Our results showed that NF is a very serious life-threatening disorder in especially diabetic patients with bad metabolic control.

NPO After Midnight

A 73-year-old male presented with a pancreatic tail mass. A staging computed tomography (CT) 1 week before operation showed a likely islet cell tumor. He underwent an uncomplicated distal pancreatectomy, splenectomy; final pathology confirmed an islet cell neoplasm. It is standard of care at the Mayo Clinic to obtain plain abdominal survey films immediately after every laparotomy, in an effort to detect retained foreign objects, allowing immediate recognition and correction of the problem, regardless of the surgical count.

An Evaluation of a Numbered Surgical Sponge Product

Surgical sponge counting is an essential patient safety measure in the OR in which all members of the surgical team must participate. The RN acting as circulator is responsible for accurately documenting sponge counts during the surgical procedure. A sequentially numbered sponge product was evaluated in a survey of OR personnel to determine ease of use and whether the product affected the flow of the surgical procedure. Survey respondents reported that the numbered sponge product was easy to use and did not lengthen or affect the flow of the surgical procedure. Respondents also indicated that the product may contribute to patient safety.

1038: Erectile Function Following Nerve Sparing Radical Prostatectomy Correlates Well with Post -Operative Penile Length in Flaccidity and at Maximum Erection. Surgical Technique Counts

1038: Erectile Function Following Nerve Sparing Radical Prostatectomy Correlates Well with Post -Operative Penile Length in Flaccidity and at Maximum Erection. Surgical Technique Counts

Retained Surgical Sponge During Breast Surgery

We present a case of a retained surgical sponge during breast surgery that was not initially detected during intraoperative radiography. After the sponge count was confirmed, a repeat film showed the missing laparotomy sponge. This report stresses the importance of including the entire surgical field during intraoperative radiography for detection of missing surgical sponges. The use of a radiofrequency identification device may be useful in this situation. INTRODUCTION We present a case report where the surgical sponge count was incorrect and yet the initial radiograph taken to detect the sponge was negative. After further confirmation of the count, a repeat film showed the sponge in the wound of a reduction mammaplasty.

Electrode insertion depth in cochlear implantees estimated during surgery, on plain film radiographs and with electrode function testing.

Three methods of determining electrode insertion depth in cochlear implantees are studied: intraoperative counting of inserted electrodes, plain film radiography using Stenvers projection and postoperative electrode function testing. In 16 cases the number of electrodes inserted in the cochlea were counted both by the surgeon at surgery and by two independent observers on plain film radiographs using Stenvers projections. The electrode function was tested postoperatively. The differences between the three methods in estimation of the number of intracochlear electrodes were analyzed with t-tests, and 95% confidence intervals (95% CI) of the mean differences were calculated. The mean difference between the radiograph observers was 0.25 electrode (95% CI, -0.69 to 1.19 electrodes.) The mean difference between radiography observations and the surgical counts was 0.60 electrode (95% CI, -0.71 to 1.91 electrodes.) The mean difference between surgical counting and electrode function testing was 0.40 electrode (95% CI, -0.66 to 1.46 electrodes.) The mean difference between radiograph observations and electrode function testing was 0.50 electrode (95% CI, -0.51 to 1.51 electrodes.) No significant differences existed between the three methods. Our findings showed similar results in estimating electrode array insertion depth with the three methods. Plain film radiography using Stenvers projection is satisfactory if imaging is indicated for determining the number of inserted electrodes.

The Efficacy of Cervical Conization in the Treatment of Cervical Intraepithelial Neoplasia in HIV-Positive Women

Abstract Objective. The aim of this study was to evaluate the efficacy of cervical conization in the treatment of CIN in HIV-positive women. Materials and Methods. Sixty-six HIV-positive women treated with cervical conization for CIN were stratified into four groups based on surgical margin and endocervical curetting (ECC) status (group 1: −margin/−ECC, group 2: +margin/−ECC, group 3: +margin/+ECC, group 4: −margin/+ECC). The rate of histologically proven recurrent CIN was calculated for each group and compared using χ 2 analysis. The effect of +margins, +ECC, degree of dysplasia, and CD4 count on the risk of recurrence was determined by logistic regression. Results. Forty-nine percent of patients with negative margins and negative ECC experienced recurrence, most within 36 months. There was no significant difference in recurrence rate for patients with positive margins (69.2%, P = 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%, P = 0.41) when compared to patients with complete excision of dysplasia. No significant difference in the mean CD4 count of patients with and without recurrent dysplasia (316 vs 390 cells/mm3, P = 0.37) was observed. Logistic regression showed only degree of dysplasia in the cone specimen to have a marginally significant linear relationship with recurrence. Conclusion. Cervical conization is not an effective method for eradicating CIN in HIV-positive women. Most patients will recur despite complete excision of dysplasia. Surgical margin status, ECC status, and CD4 count appear to have no effect on recurrence rate. Although multiple procedures were necessary in some patients, cone biopsy was effective in preventing progression to invasive cervical cancer in all cases.

The Efficacy of Cervical Conization in the Treatment of Cervical Intraepithelial Neoplasia in HIV-Positive Women

Objective. The aim of this study was to evaluate the efficacy of cervical conization in the treatment of CIN in HIV-positive women.Materials and Methods. Sixty-six HIV-positive women treated with cervical conization for CIN were stratified into four groups based on surgical margin and endocervical curetting (ECC) status (group 1: −margin/−ECC, group 2: +margin/−ECC, group 3: +margin/+ECC, group 4: −margin/+ECC). The rate of histologically proven recurrent CIN was calculated for each group and compared using χ2 analysis. The effect of +margins, +ECC, degree of dysplasia, and CD4 count on the risk of recurrence was determined by logistic regression.Results. Forty-nine percent of patients with negative margins and negative ECC experienced recurrence, most within 36 months. There was no significant difference in recurrence rate for patients with positive margins (69.2%, P = 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%, P = 0.41) when compared to patients with complete excision of dysplasia. No significant difference in the mean CD4 count of patients with and without recurrent dysplasia (316 vs 390 cells/mm3, P = 0.37) was observed. Logistic regression showed only degree of dysplasia in the cone specimen to have a marginally significant linear relationship with recurrence.Conclusion. Cervical conization is not an effective method for eradicating CIN in HIV-positive women. Most patients will recur despite complete excision of dysplasia. Surgical margin status, ECC status, and CD4 count appear to have no effect on recurrence rate. Although multiple procedures were necessary in some patients, cone biopsy was effective in preventing progression to invasive cervical cancer in all cases.

Surgical counts; sterilizer records; double gloving; bowel protocols; surgical preps; safety straps

Surgical counts; sterilizer records; double gloving; bowel protocols; surgical preps; safety straps

Intraoperative Nursing Activities Performed by Surgica Technologists

In this study of delegated intraoperative nursing activities performed by surgical technologists (STs) in low-risk and high-risk surgical procedures, 343 OR directors, perioperative nurses, and STs from rural, community, and medical center hospitals reported that STs frequently perform activities related to surgical counts, the sterile field, and equipment and supplies. Surgical technologists do not frequently perform tasks related to patient transportation, teaching, medication administration, OR environment, patient monitoring, and patients' rights. The investigator used nine competency statements of intraoperative nursing as a framework for the research instrument. Data analysis determined that the levels of risk in patient situations affects how frequently STs perform transportation, teaching, sterile field, OR environment, and patients' rights activities.