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Highlighting retained surgical instrument cases

Almost everyone in Indianapolis has likely heard horror stories about people who have underwent surgery later discovering that instruments doctors used in their procedures ended up getting left in their bodies. While some may have a hard time believing such tales, statistics show that not only do such accidents happen, but also that they may be more common than most would think. Information shared by the Joint Commission shows that between 2005-2012, it received reports of 772 cases of retained surgical instruments. Such errors often cause problems in patients much greater than those they originally sought surgical treatment for. 

RSI cases are recognized as being among those classified as "never events" in healthcare (meaning that under no circumstances are they considered excusable). How is it, then, that highly educated and experienced healthcare professionals can make such errors? Research data shared by the National Institutes of Health has identified certain risk factors associated with cases of RSI. These include: 

  • Emergency operations
  • Patients with a high body mass index 
  • In-procedure adjustments 
  • Cases involving multiple surgical teams

Incidents of RSI also appear to happen more frequently with women than they do with men. The same study showed that the most common item left in patients is a surgical sponge, with cases of retained instruments and needles being extremely rare. The abdominal wall/pelvic cavity/vaginal vault was also listed as the most common area of the body in which RSI cases occur. 

What may be most maddening to patients who suffer through an RSI case is that such errors are easily preventable. Performing a simple pre- and post-surgical count of all supplies and instruments used in a surgery allows surgical teams to immediately identify if such items might have been left inside patients during their procedures. 

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