Remedies Sought For Surgical Leftovers

A new report says surgeons leave something in a patient about 1,500 times a year in the United States, with possible serious medical consequences.

One system being tested to try to limit the problem uses technology similar to that in EZ Pass-type tollbooths. Another uses bar codes like the ones in stores.

The report says two-thirds of the items left behind are sponges, which "can lead to pain, infection, bowel obstructions, problems in healing, longer hospital stays, additional surgeries and in rare cases, death."

Surgical instruments are also frequently what's left behind.

Chest surgeon Dr. Jeffrey Port is part of a team working to cut down on surgical mistakes. He co-founded RF Surgical Systems (http://www.rfsurg.com), whose system uses RFID chips, like the ones in EZ-Pass-type units, to try to make sure everything that's supposed to come out of the patient after an operation makes it out. The system is being used at several hospitals and tested at others.

He explained on The Early Show Wednesday that the chips are embedded in the items used in the surgery. When the procedure ends, doctors can scan the patient as a toll booth would scan an EZ Pass card. If something is detected inside, physicians know they need to retrieve it. The estimated added cost for an operation is $40.

The other system under evaluation uses printed bar codes attached to instruments and sponges. The items are scanned on their way in, and scanned again on their way out. Port suggests that the bar code system may not be as reliable as the RFID chip approach, because bar codes need to be directly scanned, as they are at the supermarket, while RFID chips will turn up on a scan even if they're obscured.

Port notes that, whichever system becomes the standard, whether it's his company's, the barcode one, or a future invention, the problem is indeed being addressed.

Port explained that, in a surgical procedure, it's the nurses' responsibility to keep track of items such as sponges and clamps. They count them at the start, and count again at the end.

But, some surgeries go beyond changes in nurses' shifts, and human error might produce an incorrect count. Also, many procedures involve just one nurse, and the counting tends to need to be done at the most critical moments during the procedure, when the nurse has many other important tasks to perform.

Also, counting these things isn't as easy as it sounds. Items can be passed from one member of the surgical team to another with regularity, and tens or even hundreds of items are often involved. A procedure might use 200-300 gauze products alone.

And, as a practical matter, the way sponges are used during surgery frequently leaves them stuck together in blood-soaked heaps, making them very hard to separate and count, and easy to miss. They also might fall on the floor or get stuck in the clothing of a member of the surgical team.

If a count is made, and there is a discrepancy, the surgery needs to continue until everyone is satisfied that everything has been removed. That could mean more time for the patient on a ventilator, or under anesthesia, etc. Relatives who were expecting a certain surgery length are suddenly made to worry because the surgery is running beyond schedule. Or, in the worst-case scenarios, a delicate incision may need to be reopened, ruining the work that was just performed.

The instances in which items are most likely to remain in the patient after surgery are the ones when the count at the end matches the count at the start, but the count at the end isn't actually correct.

Eighty percent of items left in patients are gauze products --towels or sponges, Port says. The other 20% are clamps/retractors.

Gauze can be a major threat to health if left behind. It can clump and cause blockages. It can mimic tumors. It can cause perforations in the intestinal wall/ bowel. It can cause infection and internal bleeding.

Solid instruments like clamps and retractors can cause internal puncture wounds.

Some surgical procedures present more of a risk than others. They include surgery on obese patients, procedures lasting more than five-to-six hours, surgeries performed late at night, surgeries that include shift changes involving nurses, etc., emergency trauma surgery (meaning there's no time to count beforehand, and not as firm a roadmap as with a pre-planned operation), procedures involving multiple surgical teams (for instance, both a vascular surgical team and a plastic surgical team), and surgeries involving large amounts of blood.