Surgery is one of the most common treatment options, and in some cases, it can be a patient’s only option. In the past, surgery was linked to poor outcomes and high complication rates. But in the last century, with the help of advancements in antibiotic therapy and asepsis, surgery has become a very safe treatment procedure.
However, it is not 100% safe, and every surgery carries the risk of potential complications. Aside from the risks inherent within each procedure, hospital errors and medical malpractice during surgery can have lasting, negative effects on a patient. That is why surgical associations and organizations research and publish guidelines, with the goal of reducing the occurrence of surgical complications and medical malpractice. One of the most detailed guidelines is published by the World Health Organization (WHO Guidelines for Safe Surgery). According to the WHO, it is important to ensure that the following recommendations are followed: prevention of infection of surgical site, anesthesia safety, and surgical team safety. 1
In order to prevent the infection of the surgical wound, the basic principles of asespsis and antisepsis should be followed. The surgeon and all members of surgical team should wash their hands, instruments should be sterilized before the surgery, antibiotics should be administered according to the recommendations before the surgery, the skin around the incision site should be prepared and draped in a sterile manner, the wound should be treated with caution, and surgeons should try to avoid unnecessary trauma to the tissue. Failure to follow any of these recommendations can lead to a wound infection. 1
Anesthesia is one of the most important parts of every surgery. The anesthetist should be well trained in order to provide a safe anesthesia. The machine should be checked prior to surgery, and the patient’s vitals (blood pressure, heart rate, oxygen saturation, body temperature) should be monitored throughout the entire surgical procedure. 1
And last but not least, a safe surgical team should be well organized and have excellent communication in order to be best prepared for the surgery. The surgical team can reduce hospital error by confirming that they have the correct patient as well as all the correct information for the site and procedure. The patient should sign an informed consent form prior to surgery and confirm any possible allergies. The nurse working at the surgery table should note any missing surgical sponges, gauzes, or instruments in order to prevent retained foreign objects in the body and later complications. 1
If there is a breach of the standard of care, it can lead to severe and sometimes life-threatening consequences. Some of the most devastating instances of medical malpractice occur when a surgical instrument or sponge is inadvertently retained in the wound. It is hard to imagine that a well-trained surgeon could really forget to remove an instrument from the patient’s body, but this kind of surgical error does occur, and when it does, seeking the representation of a medical malpractice attorney may be the only way to ensure you receive the compensation you’re entitled to. Some reports claim that it happens once in every 1000-7000 surgeries. 2 3 4 In the USA alone, over 1500 cases are reported each year. 5
Retained foreign objects
The human body is not used to having a foreign body or material inside it (with the exception of endoprothetic materials, which are compatible). In the presence of a foreign material, the body will react and try to defend itself by initiating an inflammatory reaction. 4 In the event that the foreign material remains inside the body for a longer period of time, it can cause serious complications and even death.
Surgical instruments or sponges are most frequently forgotten during intraabdominal and intrathoracic surgeries. 6
Surgical sponges are retained the most often, followed by needles and instruments. 7
Important factors which contribute to a higher risk of retention of foreign objects are emergency surgeries, unplanned changes made during the surgical procedure, and a high BMI of the patient. 8
The main goal of surgery is to solve the problem patient has. If the surgeon leaves an instrument or sponge inside the body, that object can trigger further symptoms and create even more problems for the patient than they had before they checked into the hospital.
A patient can show symptoms immediately following surgery, or they may only notice something is wrong months or even years later. Often, they may not even connect their new symptoms to the surgery itself.
One study claims that every patient with a retained foreign body had symptoms after the surgery. Of those, the most common were sepsis caused by intestinal obstruction or fistula (tunnel) between the intestines and skin, abdominal pain, and a palpable mass. Even when the foreign object is removed, there is a high chance (18%) that a new surgery will be required in order to solve the remaining problems. 10% of the patients that required a second surgery died. 9
Another study claims that 69% of patients required a revision surgery after the retained instrument or sponge was diagnosed. These patients also have a much higher chance of having an emergency surgery (33% vs 7%). 8
Patients with a foreign body can have symptoms similar to an infection or abscess (puss formation) shortly after surgery or within a few months. 4
Lincourt et al. claim that, patients with retained foreign objects have a higher chance of multiple major surgical procedures. 6 Surgical instruments are usually well visualized using X-rays, while sponges need to be identified using more specific imaging techniques, like a CT or MRI scan. 4 In an operating theatre, the scrub nurse is responsible for counting the sponges and instruments, but he or she does so under the direction of the surgeon. 4
Every nursing organization has recommendations and standards for counting the surgical instruments and sponges in order to prevent inadvertent retention. 10 11 Most of them recommend that the scrub nurse counts sponges and that the circulating nurse performs a recount. Each time, the number of sponges should be documented.
Lately, new systems have been designed to automatically count surgical sponges and prevent possible human error. This system is based on the use of bar-coded sponges instead of regular surgical sponges. It has showed an improvement in detection of surgical sponges. 12
This can lead to significant decrease in the incidence of retained surgical instruments and sponges, though these systems and procedures have not been implemented in most hospitals in the United States. Until they are, this kind of hospital error will continue to cause devasting and unnecessary harm to many patients. If you or your loved ones have suffered from complications, infection, pain, disability, or impairment resulting from surgical errors, you may be entitled to compensation for your pain and suffering, lost wages, reduction in future earning capacity, hospitalization and re-hospitalization expenses, and other types of injuries.
Beau Correll is a medical malpractice attorney who focuses on personal injury, including wrongful death, cases. If you are looking for medical malpractice lawyers in Virginia available for a free consultation to help you determine how to pursue your medical malpractice case and receive the compensation you deserve, reach out to us. Call us at the number listed at the top of our site for free case evaluation or fill out this quick form (it takes about 30 seconds).
1. WHO, WHO Guidelines for Safe Surgery 2009, available at http://apps.who.int/iris/bitstream/handle/10665/44185/9789241598552_eng.pdf
2. Bani-Hani, Kamal E., Kamal A. Gharaibeh, and Rami J. Yagha. “Retained Surgical Sponges (Gossypiboma).” Asian Journal of Surgery 28.2 (2005): 109-115. Web. 20 May 2018.
3. Egorova NN, et al. “Managing The Prevention Of Retained Surgical Instruments: What Is The Value Of Counting? – Pubmed – NCBI .” Ncbi.nlm.nih.gov. N. p., 2018. Web. 20 May 2018.
4. Zejnullahu, Valon A. et al. “Retained Surgical Foreign Bodies After Surgery.” Open Access Macedonian Journal of Medical Sciences 5 (2017): n. pag. Web. 20 May 2018.
5. P, Brisson. “Prevention Of Retained Foreign Objects. – Pubmed – NCBI .” Ncbi.nlm.nih.gov. N. p., 2018. Web. 20 May 2018.
6. Lincourt, Amy E. et al. “Retained Foreign Bodies After Surgery.” Journal of Surgical Research 138.2 (2007): 170-174. Web. 20 May 2018.
7. “Retained Surgical Sponges, Needles And Instruments | The Annals Of The Royal College Of Surgeons Of England.” The Annals of The Royal College of Surgeons of England (2018):. Web. 20 May 2018.
8. Gawande AA, et al. “Risk Factors For Retained Instruments And Sponges After Surgery. – Pubmed – NCBI .” Ncbi.nlm.nih.gov. N. p., 2018. Web. 20 May 2018.
9. Gonzalez-Ojeda A, et al. “Retained Foreign Bodies Following Intra-Abdominal Surgery. – Pubmed – NCBI .” Ncbi.nlm.nih.gov. N. p., 2018. Web. 20 May 2018.
10. Nurses, Association. “Guidelines For Perioperative Practice – Clinical Resources – Association Of Perioperative Registered Nurses.” Aorn.org. N. p., 2018. Web. 20 May 2018.
11. “Australian College Of Perioperative Nurses :: Standards.” Acorn.org.au. N. p., 2018. Web. 20 May 2018.
12. Greenberg CC, et al. “Bar-Coding Surgical Sponges To Improve Safety: A Randomized Controlled Trial. – Pubmed – NCBI .” Ncbi.nlm.nih.gov. N. p., 2018. Web. 20 May 2018.