Understanding Retained Surgical Items: A “Never Event”
Retained surgical items (RSIs) are foreign objects accidentally left inside a patient's body after an operation or invasive procedure. This is considered a serious, preventable error, or “never event,” that should never occur in a healthcare setting. Studies estimate that retained items occur in approximately 1 in 5,500 to 7,000 surgeries, a frequency that underscores persistent risks despite safety measures. Incidents are more likely to occur during emergency surgeries, complex procedures, or when there is an unexpected change in the operation. A breakdown in communication among surgical staff, a hurried operating room environment, and miscounted surgical tools are all major contributing factors.
The Range of Retained Items and Their Immediate Impact
Retained objects vary in size and composition, and each poses a unique risk to patient health. The most commonly retained item is the surgical sponge, often due to its extensive use to soak up blood and fluids, which makes it easy to obscure among bodily tissues. Other retained items can include:
- Sharps: Scalpel blades, suture needles, and device fragments like broken drill bits
- Instruments: Clamps, forceps, retractors, and scissors
- Miscellaneous Items: Small items like screws, vessel loops, and broken catheter tips
When a foreign object is left inside, the body's immune system immediately recognizes it as an invader, triggering an inflammatory response. This can cause a range of issues, from localized inflammation to more severe systemic reactions. While some items might initially cause a minimal reaction, others, particularly sponges, can become a breeding ground for bacteria, significantly increasing the risk of infection.
Delayed Symptoms and Diagnostic Challenges
Symptoms of a retained surgical item can appear immediately after surgery or, in some cases, not for months or even years. This delay can lead to a prolonged period of undiagnosed illness and suffering. The most common symptom is persistent and unexplained abdominal pain. However, other symptoms can include:
- Fever and swelling
- Digestive problems, including constipation or bowel obstruction
- Infections and abscess formation
- Unexplained fatigue, nausea, or weight loss
Diagnosing a retained item can be challenging because these symptoms can mimic other post-operative complications. For example, a retained surgical sponge, sometimes called a “gossypiboma,” can resemble a tumor on imaging. Physicians rely on diagnostic imaging to identify the problem, including X-rays, CT scans, and ultrasound. Fortunately, many modern surgical sponges have radiopaque markers to make them visible on X-rays.
Severe Medical Complications
The consequences of a retained surgical item can be severe and life-threatening. Without intervention, an RSI can lead to permanent disability or death. Common complications include:
- Sepsis: A life-threatening systemic infection that triggers a chain reaction of inflammation throughout the body.
- Organ Damage: Sharp instruments can perforate organs or blood vessels, causing internal bleeding.
- Bowel Obstruction: Sponges and other items can cause blockages in the intestines.
- Fistula Formation: A retained object can erode through internal tissues, creating an abnormal connection between two organs.
- Chronic Pain: Adhesions and scar tissue can form around the object, causing persistent pain.
For example, a New Zealand woman suffered chronic abdominal pain for 18 months after a standard C-section, only to discover a large plastic wound retractor had been left inside her. Another reported case involved a man who suffered septic shock and a stroke after two surgical clamps were left in his body.
Treatment and Recovery: The Road to Another Surgery
Once a retained surgical item is discovered, a second surgery is almost always required to remove it and repair any damage. This places the patient at additional risk and prolongs their recovery time and emotional distress. The costs associated with a second operation can be substantial, and the patient may face an extended hospital stay. Beyond the physical toll, patients often experience significant psychological trauma, including anxiety and a loss of trust in the medical system.
Prevention and Liability
To prevent RSIs, hospitals implement strict safety protocols, including meticulous surgical item counts before and after a procedure. In complex, high-risk procedures or emergencies, some hospitals use advanced technologies like RFID (Radio-Frequency Identification) tags on surgical sponges, which allow for electronic tracking to confirm all items have been removed. The Association of periOperative Registered Nurses (AORN) provides guidelines for prevention, emphasizing teamwork, communication, and visual inspection. Information regarding these standards is available through resources like the AORN website, which offers guidelines and further reading on preventing retained surgical items.
From a legal standpoint, leaving a foreign object in a patient is considered clear evidence of negligence, falling under the legal doctrine of res ipsa loquitur, or “the thing speaks for itself”. This makes it a strong case for a medical malpractice lawsuit, allowing the patient to seek compensation for medical expenses, lost wages, and pain and suffering.
Common Retained Surgical Items and Their Consequences
| Item | Likelihood of Retention | Primary Risks | Discovery Timeline | Special Characteristics |
|---|---|---|---|---|
| Surgical Sponges | High (most common) | Infection (sepsis), abscess, fistula formation | Weeks to years, vague symptoms | Soft, can blend with tissue, some have radiopaque markers |
| Surgical Instruments | Lower | Organ perforation, internal bleeding, obstruction | Can be immediate or delayed; metal detectors | Made of durable metal, can be large or small |
| Needles/Blades | Lower | Puncture vital organs, internal bleeding | Often noticed quickly, but small size can lead to errors | Sharp, small, pose immediate puncture risk |
| Device Fragments | Lower | Local tissue reaction, migration | Can be intentionally left if removal risk is higher | Small, hard to retrieve if broken off |
Protecting Yourself from Retained Surgical Items
- Choose Accredited Hospitals: Research a hospital's patient safety record, as some facilities have stronger protocols than others.
- Ask About Safety Measures: Before surgery, ask the medical team about their procedures for counting surgical items and ensuring nothing is left behind.
- Be Aware of Symptoms: Understand the potential signs of a retained item and pay close attention to any unexplained or persistent pain after surgery.
- Seek a Second Opinion: If you experience concerning symptoms post-surgery that are dismissed by your original care team, seek a second medical opinion.
- Document Everything: Keep detailed records of your symptoms, medical visits, and any communications with healthcare providers.
Conclusion
What happens if a surgeon left something inside you can range from chronic discomfort to life-threatening complications, often requiring additional surgery and causing significant emotional and financial stress. While RSIs are considered preventable, they persist due to human and systemic failures. Patients must be aware of the symptoms and risk factors, and understand their legal rights, which are often protected under medical malpractice laws. Stronger communication within surgical teams and the adoption of advanced tracking technology are key to reducing these critical errors and ensuring patient safety. Ultimately, preventing RSIs requires a commitment from healthcare providers to uphold the highest standards of care and accountability.
