Why surgical items get left inside

Here’s a distressing thought: Surgical teams are more likely to leave sponges or medical instruments inside your body during an emergency operation or if you’re overweight.

All hospitals have procedures requiring that operating room tools and sponges be inventoried before and after surgery. But in rare cases, even when rules are followed, objects are left behind, especially where there’s potential for disorganization, said Dr. Atul A. Gawande, lead author of a study in last week’s New England Journal of Medicine.

Gawande, a surgeon at Brigham and Women’s Hospital in Boston, studied 54 cases in which foreign objects were left in patients’ bodies. In more than two-thirds of them, hospital staff properly documented the whereabouts of instruments. The remaining cases lacked such documentation.

Although consequences can range from infections and bowel perforation to death, researchers found a single fatality among the cases studied; 37 cases were resolved by additional surgery.

Problems were more likely during emergency surgery, when the original surgical plan changed, and with heavier patients.

“The way to further reduce these errors from happening is to step up the use of X-rays, CT scans and other radiographic technologies to ensure that surgical objects are not left behind,” said Gawande, who estimated that such errors occur about 1,500 times annually in the U.S.

The findings were based on an analysis of insurance claims from a Massachusetts medical malpractice insurer between 1985 and 2001.