“I’m Missing a Sponge!” New Techniques in the Prevention of Foreign Body Retention

Retained surgical items (RSIs) can include any surgical equipment (i.e., sponge, instrument, needle) unintenti onally left inside a patient after an operation. RSIs have an estimated incidence between 1 in 5500 and 18,760 operations. RSIs may result in serious, even fatal injuries, and infectious complications, which require additional medical care, frequently manifested as increased length of stay, readmissions, and reoperations. Additionally, retained surgical item cases frequently lead to litigation and negatively affect the reputation of clinicians and hospital systems. Risk factors include incorrect surgical count, unexpected intraoperative factors, multiple surgical teams, lack of surgical counts, more than one sub-procedure, duration of operation, and high estimated blood loss. Standard prevention procedures include manual surgical counting and intraoperative radiographs for incorrect manual counts. Both have limitations with sensitivities around 77% for surgical counting and 67% for intraoperative radiographs. This chapter describes new technologies developed as adjuncts to counting, including bar-coded sponges and radiofrequency tags.