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Sponges, Surgical Tools Sometimes Left in Kids After Operation

By Steven Reinberg
HealthDay Reporter

MONDAY, Nov. 15 (HealthDay News) -- It rarely happens, but that's little comfort for those involved: Sometimes surgical instruments and sponges are left inside children undergoing surgery, according to researchers from Johns Hopkins University.

Children suffering from such mishaps were not more likely to die, but the errors result in hospital stays that are more than twice as long and cost more than double that of the average stay, the researchers found.

And that's not even counting the psychological toll on families.

"Certainly, from a family's perspective, one event like this is too many," said lead researcher Dr. Fizan Abdullah, an assistant professor of surgery at Johns Hopkins. "Regardless of the data, we as a health care system have to be sensitive to these families," he said.

"The amazing thing is that when you look at the numbers, it translates to one event in every 5,000 surgeries," Abdullah added. "When there are hundreds of thousands of surgeries being performed on children across the U.S. every year, that's a lot of patients."

The report is published in the November issue of the Archives of Surgery.

For the study, Abdullah's team collected data on 1.9 million children under 18 who were hospitalized from 1988 to 2005. Of all these children, 413 had an instrument or sponge left inside them after surgery, the researchers found.

The mistakes occurred most often when the surgery involved opening the abdominal cavity, such as during a gynecologic procedure. Errors were less likely to occur during ear, nose, throat, heart and chest, orthopedic and spine surgeries, Abdullah's group notes.

Of the 17 patients who had a surgical tool left in them during a gynecologic procedure, 15 had undergone ovarian cyst or cancer-related procedures, one had had a cesarean section and one had undergone a procedure for pelvic scars.

"It's not that people are lazy or careless," Abdullah said. "What happens sometimes is there are places where a sponge will slip, because the body has areas that are hard to see or reach, particularly in the abdomen," he explained.

In the operating room there are safety procedures, such as counting the sponges and instruments before and after the operation. If these procedures were not in place, many more errors would occur, Abdullah added.

After surgery, patients who have a foreign body left inside them often develop punctures, lacerations, infection, fever and pain. An image of the area will reveal the object, and surgeons must perform another operation to remove it.

All this adds considerable time and money, Abdullah noted.

For children who had objects left in them, hospital stays increased from an average of three days to a week. Moreover, average costs soared from $40,502 to $89,415, the researchers found.

"From a health care system's perspective, we need to be more focused on this issue, and we need to be putting in additional safety measures and additions to our procedures and protocols to prevent these events from happening," Abdullah said.

Commenting on the study, Dr. Juan E. Sola, chief of the division of pediatric and adolescent surgery and an associate professor of surgery at the University of Miami Miller School of Medicine, said that "any incident above zero is something we need to address."

However, overall, these events are few and far between, he noted.

Sola noted that new systems involve bar-coding every instrument and sponge. Scanning the code after they are removed insures that no objects are left behind, because a computer is keeping track of all the instruments and sponges used, he explained.

"Technology will eliminate a lot of these human errors," Sola said.

More information

For more information on patient safety, visit the U.S. National Library of Medicine.

SOURCES: Fizan Abdullah, M.D., Ph.D., assistant professor of surgery, Johns Hopkins University, Baltimore, Md.; Juan E. Sola, M.D., chief, division of pediatric and adolescent surgery, associate professor of surgery, University of Miami Miller School of Medicine; November 2010, Archives of Surgery

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