Beyond counting: current evidence on the problem of retaining foreign bodies in surgery?

摘要

Retained foreign bodies (RFB) are a rare but devastating and preventable complication in surgery. Despite an increasing body of literature over the last decade, it has been difficult even to accurately estimate how frequently these events occur. An estimate based on claims data suggests the incidence is in the range of 1 in 9000 to 1 in 19000. The current approach to the prevention of RFB relies on a standardized counting protocol developed by the Association of PeriOperative Registered Nurses (AORN) and adapted in operating rooms (ORs) across the country. The counting process is labor-intensive and has been shown to negatively affect case progression and team performance. In addition, to date, there is no data regarding the accuracy or reliability of manual counting. Despite this uncertainty regarding the limitations of the current approach, new technologies are being investigated as adjuncts to the manual counting protocol. The 2 articles published in this issue of Annals of Surgery take an importantstep toward understanding the utility of our current approach to the prevention of RFB. The paper by Egorova et al identifies cases involving count discrepancies through the hospital reporting system at a large academic institution and its affiliates. By linking these reports to administrative data, they are able to estimate the rate of RFB as well as evaluate the ability of the counting protocol to detect RFB as they occur. Finally, they provide the first cost analysis of miscounts and compare it with another approach, performing universal radiographs in the operating room.