Sponge count often off after surgery

NEW YORK (Reuters Health) - The routine count of sponges and instruments used and retrieved during surgery comes up with a discrepancy in 1 in 8 operations, investigators report. However, almost always the missing items are found before any harm is done.

The study shows the value of the so-called "surgical count," say the researchers.

They explain that it's estimated that surgical items are actually left in patients' bodies in one in every 5,000 surgeries. The standard way to prevent such accidents is for the surgery team to count and document all instruments before and during surgery, and again before the surgeon closes the incision.

However, most incidents in which an instrument is left behind occur when the team mistakenly believes it has accounted for all surgery tools, so some surgeons consider the system unreliable -- and they sometimes ignore discrepancies in the instrument count.

In the new study, published in the Annals of Surgery, researchers observed 148 operations at one large medical center that uses a standard protocol for counting surgical instruments.

They found that count discrepancies occurred in 19 of the operations. In 59 percent of these cases, the discrepancy detected a misplaced sponge, needle or other instrument, according to the researchers, led by Dr. Caprice C. Greenberg of Brigham & Women's Hospital in Boston.

In 3 percent of the discrepancies, a surgery team member had incorrectly counted the instruments, while 38 percent involved an error in documenting the count.

The fact that the majority of the discrepancies were real underscores the point that surgeons should take these situations seriously, according to Greenberg's team.

"Despite the recognized limitations of manual surgical counts," the researchers write, "discrepancies should always prompt a thorough search and reconciliation process and never be ignored."

The old-fashioned counting method could, however, be improved upon, the researchers note, pointing out that "technological solutions" are being studied. One example is sponges tagged with radiofrequency ID chips that could allow surgeons to detect any left-behind sponges by waving a wand over the patient's body.

SOURCE: Annals of Surgery, August 2008.