Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval

Stawicki, Stanislaw P; Cook, Charles H.; Anderson, Harry L.; Chowayou, Laurie; Cipolla, James; Ahmed, Hesham M.; Coyle, Susette M.; Gracias, Vicente H.; Evans, David C.; Marchigiani, Raffaele; Adams, Raeanna C.; Seamon, Mark J.; Martin, Niels D.; Steinberg, Steven M.; Moffatt-Bruce, Susan D.

doi:10.1016/j.amjsurg.2013.09.029

Cited by 66 publications

(73 citation statements)

References 17 publications

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“…Patients undergoing emergency surgery, those with high BMI, intraoperative complications, unplanned or unforeseen change in surgical procedure, longer operation duration, inexperienced staff, incorrect sponge count, shift changes for surgical team, and involvement of more than the surgical team during the operation are all associated with increased gossypiboma risk [21,22]. However, gossypiboma can be easily prevented by simple precautions like educating the staff, tagging the sponges with markers or intra-and perioperative multiple counts and materials should reduce the incidence of gossypiboma.…”

Section: Discussionmentioning

confidence: 99%

Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

et al. 2015

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Gossypiboma is the term used to describe a retained non-absorbable surgical material that is composed of cotton matrix which leads to serious surgical complications for both patient and surgeon. Its incidence is not precisely known probably due to medico-legal importance of this potential complication. The condition may manifest either as asymptomatic or severe gastrointestinal complications. The increasing number of recent reports in the literature implies that this issue still remains as an important problem to be solved after intraabdominal surgery. In this report, we aimed to emphasize this potential complication by presenting the clinical outcomes of our 14 patients who underwent different surgical interventions for gossypiboma. Between February 2009 and October 2014, a total of 14 patients who underwent surgery for gossypiboma were reviewed retrospectively. The patients were analyzed with regard to demographic characteristics, initial diagnosisprior surgery, clinical presentation, the interval period from the first operation to last definite operation, diagnostic methods, gossypiboma location, definite surgery, and postoperative outcomes. A total of 14 patients including 6 (42.9 %) male and 8 (57.1 %) female with a median age of 41.4± 12 years (22-61 years) enrolled in this study. The prior surgery of 10 (71.4 %) patients was performed by general surgeons, while 4 (28.6 %) patients were operated by gynecologists. The interval period from prior surgery to definite surgery ranged from 14 days to 113 months. Three (21.4 %) patients were asymptomatic, whereas the vast of the patients were complicated (fistula, ileus, wound infection). Gossypiboma was removed by open surgery, laparoscopic surgery, and endoscopic intervention in 10, 2, and 1 patient, respectively. Removal was performed from perineal wound side in one patient. Removal was enough for definitive treatment in 10 (71.4 %) patients whereas bowel resection and primary repair was performed in 4 (28.6 %) patients due to fistula or perforation. One patient died from intra-abdominal sepsis on postoperative 13th day. Gossypiboma should strongly be considered in differential diagnosis of any postoperative patient with mild gastrointestinal symptom or with persistent wound infection. Adequate surgical intervention should be planned as soon as possible either to prevent further complications or to overcome medico-legal problems, when gossypiboma is detected.

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Section: Discussionmentioning

confidence: 99%

Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

et al. 2015

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“…These various items can cause a variety of diferent responses depending on how long and where these items were misplaced. The duration of time between the index procedure and recognition has been found to correlate with symptomatology [4]. Local and systemic signs and symptoms associated with retained foreign objects can include abdominal pain, abscess formation, nausea and emesis, wound complications, palpable mass, systemic inlammatory response, and ileus.…”

Section: Overview Of Retained Surgical Foreign Bodiesmentioning

confidence: 99%

“…portend toward retained surgical foreign bodies [3,4,6,7,[9][10][11]. In one example, Gawande et al found that emergent procedures were of very high risk for retained foreign bodies [7].…”

Section: Studies Difer On the Risk That Emergent Procedures And Elevamentioning

confidence: 99%

“…Local and systemic signs and symptoms associated with retained foreign objects can include abdominal pain, abscess formation, nausea and emesis, wound complications, palpable mass, systemic inlammatory response, and ileus. Furthermore, ibrosis, purulence, erosion, and istulization can occur with long-term retention of foreign objects after surgery [4].…”

Section: Overview Of Retained Surgical Foreign Bodiesmentioning

confidence: 99%

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Retained Foreign Body

Bean¹,

Swaroop²

2018

Vignettes in Patient Safety - Volume 2

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Retained foreign bodies after surgeries or procedures are a rare complication with great consequences. The most commonly retained surgical items are guidewires, surgical sponges, and suture needles. The procedure at highest risk for retained foreign bodies is central venous catheterization. The literature regarding speciic risk factors that increase the potential for retained surgical items varies. Evidence suggests that procedures with blood loss over 500 mL, lack of or an incorrect surgical instrument and sponge count, longer procedures, and unexpected intraoperative events all increase the risk of retained surgical items. There is conlicting evidence on the efect that elevated body mass index (BMI) or the emergent nature of a procedure has on retained surgical item risk. Interventions aimed at preventing retained foreign bodies include surgical counts, mandatory imaging after procedures, bar-coding of items used during surgery, and radiofrequency detection systems. These interventions have varying detection rates. Regardless of the safety measures used, none are perfect and a high index of suspicion must be maintained to prevent retained surgical foreign bodies.

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“…Another critical realization was that majority of AHRE are not the result of an error atributable to a single person or factor, and instead tend to represent a conluence of two or more co-occurrences [21]. In addition, active and informed participation of an empowered patient is critical to the efective implementation of healthcare safety measures (Figure 3) [22].…”

Section: Vignettes In Patient Safety -Volumementioning

confidence: 99%

Introductory Chapter: The Decades Long Quest Continues Toward Better, Safer Healthcare Systems

Stawicki¹,

Firstenberg²

2017

Vignettes in Patient Safety - Volume 1

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Natural history of retained surgical items supports the need for team training, early recognition, and prompt retrieval

Cited by 66 publications

References 17 publications

Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

Intra-abdominal Gossypiboma Revisited: Various Clinical Presentations and Treatments of this Potential Complication

Retained Foreign Body

Introductory Chapter: The Decades Long Quest Continues Toward Better, Safer Healthcare Systems

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