gauze left intentionally during surgery?

[remotefuse]

I was reading about items left behind during surgery, and came across an interesting statistic. According to the article I was reading, during a study, upwards of 50% of gauze left behind was left intentionally by the surgeon for one reason or another. Ive never heard of such a practice. Do any of you have any idea of what this is about. just curious, but it sounds dubious to me.

[RNperdiem, RN]

Sometimes a patients comes back to the Surgical ICU with an open abdomen. The abdomen is packed and sealed with the idea of another trip or two to the OR before an abdomen can be closed. Sometimes there is another washout to be done or there is too much swelling to close.

[LovingLife123]

I often see this with my surgical patients. Most are open belly patients and I recently saw one that had an abscess in the buttock. They soaked the gauze in betadine.

[remotefuse]

It was a Washington Post article, so I'm not entirely confident in its validity. It did not seem like the gauze was left to be taken out later, but after counting sponges, and after realizing they are short, the surgeon still deciding to close and suture. Seems like sepsis waiting to happen.

Here's the article if anyone is interested

When your surgeon accidentally leaves something inside you - The Washington Post

[remotefuse]

I often see this with my surgical patients. Most are open belly patients and I recently saw one that had an abscess in the buttock. They soaked the gauze in betadine.

Even if the gauze is soaked in betadine, wouldn't you be expecting to remove it at some point? Not suture and move on with life right?

[klone, MSN, RN]

It was a Washington Post article, so I'm not entirely confident in its validity. It did not seem like the gauze was left to be taken out later, but after counting sponges, and after realizing they are short, the surgeon still deciding to close and suture. Seems like sepsis waiting to happen.

Here's the article if anyone is interested

When your surgeon accidentally leaves something inside you - The Washington Post

I interpreted that to mean not that the surgeon knew the sponge was in the cavity and left it in intentionally, but that s/he knew the count was off and opted to close up anyway, believing that the sponge would be found. While negligent and going way against best practices, that's not *intentionally* leaving a sponge in the cavity.

The *intentional* leaving in of sponges were for medical reasons, as the article stated.

Cerese said surgeons may continue closing while a recount is being conducted or because it's important to limit the time a patient is under anesthesia

[klone, MSN, RN]

When they looked at 824 reports of sponges that remained inside surgery patients, the authors found that the majority, 525, were left intentionally by surgeons for medical reasons. Forty-one were unintentional; of those, 28 were discovered after the surgeon had closed the surgical cavity.

Only a small percentage were unintentional. The majority were for the reasons described by other posters in this thread.

What I don't understand is, if 525 were intentional, and 41 were unintentional, what where the other 258?

[JKL33]

Category Sponge Count and retained sponge events (n = 824)

n / %

Intentionally retained 525 / 64

Unintentionally retained 41 / 5

Counts incorrect and not reconciled 172 / 21

Count not completed/not done 58 / 7

Counts incorrect, but reconciled before closure 28 / 3

(slash marks added for clarification = n / %)

Study

[klone, MSN, RN]

You're awesome. Not sure why I didn't think to do that.

So the article wording was incorrect/misleading. It was actually 824 cases of the count being off, not 824 cases of "sponges that remained inside surgery patients" as stated in the article.

And whaaaa? 7% of these cases, they never did a freaking count? What kind of backwards shenanigans is that??

[JKL33]

Yeah - 7% not counted and 21% incorrect count not reconciled (?!)...

[Rose_Queen, BSN, MSN, RN]

Yeah - 7% not counted and 21% incorrect count not reconciled (?!)...

Sometimes it's simply impossible to find a missing needle that is smaller than an eyelash- we don't even x-ray for needles that are a 7-0 or smaller as they can't even be seen on an x-ray. Other times, the initial count may have been off or someone added something to the table that wasn't there initially- the x-ray is negative but the count never matches.

The crazy number of ads that jumped around on the page over the text on the original link made it impossible for me to read the whole WaPo article- did they specify that all of those were retained sponges?

[JKL33]

Yes, I believe the figures the article deals with are sponges only.

From the complete study (linked above) here is the larger breakdown:

Table 1

Retained Surgical Items and Surgical Count Events by Type of Item

Table 1 Retained Surgical Items and Surgical Count Events by Type of Item Item type Retained surgical item (n = 428) Surgical count issue (n = 9,467)

n % n %

Needle 43 10.0 3,792 40.1

Sponge 128 29.9 2,167 22.9

Whole instrument 77 18.0 1,730 18.3

Instrument fragment 171 40.0 167 1.8

Towel 9 2.1 34 0.4

Count incomplete or not done n/a 1,577 16.7

UHC Safety Intelligence aggregate data from more than 100 participating organizations.

n/a, not applicable.

https://www.journalacs.org/article/S1072-7515(14)00384-6/fulltext