A Shameful Souvenir of Surgery

September 28th, 2012

Every year, about 4000 people enter the hospital for surgery and leave with a dangerous souvenir: a surgical instrument or item left behind in the body. Two-thirds of the time, the object is a surgical sponge, but sometimes the items are scissors, scalpels, or other large, metal items.

But even a sponge can be serious. An article in The New York Times told the story of a woman who had a hysterectomy. Four years later, after crushing pain in her abdomen, scans showed the sponge that had been left behind. It had adhered to the bladder and stomach, and to the walls of her abdominal cavity. It spread infection that required removal of a large segment of her intestine. The woman’s life is ruined–unable to work, in pain, and suffering from severe bowel issues.

How Can This Still Be Happening?

As remarkable as it sounds in these high-tech days, surgical teams still rely on a low-tech solution: They count the instruments. But when things get chaotic, or if the surgery is complicated or long, mistakes are made. There are newer ways to keep track of surgical items, such as tracking sponges through radio-frequency tags, at an additional cost of about $10 per procedure. But according to the article, many hospitals are resisting making the change from manual counting. That leaves patients at risk from something that seems so easy to control.

“In most instances, the patient is completely helpless,” said Dr. Verna C. Gibbs, professor of surgery at the University of California, San Francisco, who is also the director of NoThing Left Behind, a national surgical patient safety project. “We’ve anesthetized them, we take away their ability to think, to breathe, and we cut them open and operate on them. There’s no patient advocate standing over them saying, ‘Don’t forget that sponge in them.’ I consider it a great affront that we still manage to leave our tools inside of people.”

There seems no good reason why surgical patients are not routinely offered the highest standard of care possible–especially if the added cost is only $10 per surgery. Heck…charge and extra $20 and make a profit. I’ll bet most patients would be happy to hand over a couple of sawbucks to avoid the devastation of left-behind surgical items.

To read the full article in The New York Times, click here:  When Surgeons Leave Objects Behind