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Hoshi T. Short Report of Retained Radiopaque Marker in Gauze and Comparison of Ease of Dislodging and Breaking. Indian J Surg Oncol 2024; 15:528-530. [PMID: 39239425 PMCID: PMC11371946 DOI: 10.1007/s13193-024-01934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 03/26/2024] [Indexed: 09/07/2024] Open
Affiliation(s)
- Takuo Hoshi
- Department of Anesthesiology and Critical Care Medicine, Ibaraki Clinical and Training Center, University of Tsukuba Hospital, Koibuchi 6528, Kasama, Ibaraki 309-1793 Japan
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Al-Wageeh S, AlShoaibi IA, Abdo B, Ahmed F, Ghabisha SA, Badheeb M, Ameen M. Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings. Cureus 2024; 16:e63856. [PMID: 39100026 PMCID: PMC11297663 DOI: 10.7759/cureus.63856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. MATERIALS AND METHODS A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. RESULT Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. CONCLUSION A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations. Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.
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Affiliation(s)
| | | | - Basheer Abdo
- Department of Internal Medicine, Ibb University, Ibb, YEM
| | | | | | - Mohamed Badheeb
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Mohammed Ameen
- Department of Pharmacy Practice, Sana'a University, Sana'a, YEM
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Abo-Zahhad M, El-Malek AHA, Sayed MS, Gitau SN. Minimization of occurrence of retained surgical items using machine learning and deep learning techniques: a review. BioData Min 2024; 17:17. [PMID: 38890729 PMCID: PMC11184833 DOI: 10.1186/s13040-024-00367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
Retained surgical items (RSIs) pose significant risks to patients and healthcare professionals, prompting extensive efforts to reduce their incidence. RSIs are objects inadvertently left within patients' bodies after surgery, which can lead to severe consequences such as infections and death. The repercussions highlight the critical need to address this issue. Machine learning (ML) and deep learning (DL) have displayed considerable potential for enhancing the prevention of RSIs through heightened precision and decreased reliance on human involvement. ML techniques are finding an expanding number of applications in medicine, ranging from automated imaging analysis to diagnosis. DL has enabled substantial advances in the prediction capabilities of computers by combining the availability of massive volumes of data with extremely effective learning algorithms. This paper reviews and evaluates recently published articles on the application of ML and DL in RSIs prevention and diagnosis, stressing the need for a multi-layered approach that leverages each method's strengths to mitigate RSI risks. It highlights the key findings, advantages, and limitations of the different techniques used. Extensive datasets for training ML and DL models could enhance RSI detection systems. This paper also discusses the various datasets used by researchers for training the models. In addition, future directions for improving these technologies for RSI diagnosis and prevention are considered. By merging ML and DL with current procedures, it is conceivable to substantially minimize RSIs, enhance patient safety, and elevate surgical care standards.
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Affiliation(s)
- Mohammed Abo-Zahhad
- Department of Electronics and Communications Engineering, Egypt-Japan University of Science and Technology, New Borg El-Arab City, Alexandria, Egypt.
- Department of Electrical and Electronics Engineering, Assiut University, Assiut, Egypt.
| | - Ahmed H Abd El-Malek
- Department of Electronics and Communications Engineering, Egypt-Japan University of Science and Technology, New Borg El-Arab City, Alexandria, Egypt
| | - Mohammed S Sayed
- Department of Electronics and Communications Engineering, Egypt-Japan University of Science and Technology, New Borg El-Arab City, Alexandria, Egypt
- Department of Electronics and Communications Engineering, Zagazig University, Zagazig, Egypt
| | - Susan Njeri Gitau
- Department of Electronics and Communications Engineering, Egypt-Japan University of Science and Technology, New Borg El-Arab City, Alexandria, Egypt
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Erkan HN, Soyer Er Ö. The Retained Surgical Items Risk Assessment Scale: Development and Psychometric Characteristics. J Surg Res 2024; 296:581-588. [PMID: 38340492 DOI: 10.1016/j.jss.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Retained surgical items in operating rooms (ORs) continue to contribute significantly to medical errors. The first step in addressing the problem of retained surgical items is to identify the main risk factors. Identification of risk factors can impact OR standards and reduce such errors. METHODS The research included 270 participants. The data of the study were collected with the Sociodemographic and Clinical Characteristics Form, Operating Room Count Control Form and the Retained Surgical Items Risk Assessment Scale developed. In the analysis of the data, Content Validity Index, Cronbach α, item-total score correlation, Kuder-Richardson, Kappa, exploratory and confirmatory factor analysis, and Receiver Operating Characteristic (ROC) curve analysis were performed. RESULTS The Content Validity Index of the scale was 0.92. Kappa value was 0.993. The explained variance in the exploratory factor analysis of the scale was 50.03%. After confirmatory factor analysis, two factors were obtained for the final version of the 15 items. Factors had been determined as "Count and Surgery" and "Equipment". Among the subdimensions of the scale, Cronbach's α values were between 0.742 and 0.760, and 0.722 for the entire scale. When the ROC analysis results were examined, the cut-off point was ≥8, the specificity was 93.13%, and the sensitivity was 87.50%. The area under the ROC curve was calculated as 0.938. CONCLUSIONS The scale was presented as a valid and reliable measurement tool developed to assess the Retained Surgical Items Risk in ORs. If high-risk patients are checked and necessary precautions are taken before leaving the ORs, the incidence of retained surgical items can be significantly reduced.
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Affiliation(s)
- Hamide Nur Erkan
- Surgical Nursing Department, Afyonkarahisar Health Sciences University, Graduate Education Institute, Afyonkarahisar, Turkey
| | - Özlem Soyer Er
- Assistant Professor, Surgical Nursing Department, Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Afyonkarahisar, Turkey.
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Varlas VN, Bors RG, Mastalier B, Balescu I, Bacalbasa N, Cirstoiu MM. Gossypiboma, the Hidden Enemy of an Emergency Cesarean Hysterectomy-Case Report and Review of the Literature. J Clin Med 2023; 12:5353. [PMID: 37629395 PMCID: PMC10455589 DOI: 10.3390/jcm12165353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Gossypiboma or textiloma is a rare medical situation that can complicate the favorable evolution of a surgical case, with repercussions for the patient's prognosis. The diagnosis can be difficult due to various clinical symptoms, the time elapsed since the surgical intervention, and the imaging often not being precise in detecting textilomas. Due to the medicolegal implications, the reporting of this event is inconsistent. We present a rare case of a 28-year-old woman who presented with vague pain in the left iliac fossa 11 months after an emergency cesarean hysterectomy was performed. The preoperative imaging examination identified the presence of a subhepatic mass with dimensions of 10 × 8 cm2 and another formation in the right iliac fossa with dimensions of 11 × 9 cm2. Exploratory laparotomy found the presence of a large subhepatic gossypiboma, intimately adherent to the hepatic angle of the colon and omentum and a second one adherent to the sigmoid colon, small intestine, and parietal peritoneum. The particularity of this case is given by the simultaneous presence of two textilomas with inconclusive evolution, which can make the differential diagnosis difficult to achieve. For a better assessment of the risk of occurrence of this pathology and the identification of a correct prevention strategy, we performed an extensive search and a review of all the articles published in the PubMed database, identifying 57 articles. In conclusion, emergency surgery increases the risk of this complication, and, as a result, prevention can be achieved by following existing protocols in the operating room.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania;
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania;
| | - Bogdan Mastalier
- General Surgery Clinic, Colentina Clinical Hospital, 020125 Bucharest, Romania
- General Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, Ponderas Academic Hospital, 021188 Bucharest, Romania;
| | - Nicolae Bacalbasa
- Department of Visceral Surgery, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Monica-Mihaela Cirstoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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Schwappach D, Havranek MM. Are temporal trends in retained foreign object rates after surgery in Switzerland impacted by increasing coding intensity? A retrospective analysis of hospital routine data from 2000 to 2019. BMJ Open 2023; 13:e075660. [PMID: 37562932 PMCID: PMC10423772 DOI: 10.1136/bmjopen-2023-075660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES Retained foreign objects (RFOs) after surgery can cause harm to patients and negatively impact clinician and hospital reputation. RFO incidence based on administrative data is used as a metric of patient safety. However, it is unknown how differences in coding intensity across hospitals and years impact the number of reported RFO cases. The objective of this study is to investigate the temporal trend of RFO incidence at a national level and the impact of changes in coding practices across hospitals and years. DESIGN Retrospective study using administrative hospital data. SETTING AND PARTICIPANTS 21 805 005 hospitalisations at 354 Swiss acute-care hospital sites PRIMARY AND SECONDARY OUTCOME MEASURES: RFO incidence over time, the distribution of RFOs across hospitals and the impact of differences in coding intensity across the hospitals and years. RESULTS The annual RFO rate more than doubled between 2000 and 2019 (from 4.6 to 11.8 with a peak of 17.0 in 2014) and coincided with increasing coding intensity (mean number of diagnoses: 3.4, SD 2.0 in 2000; 7.40, SD 5.2 in 2019). After adjusting for patient characteristics, two regression models confirmed that coding intensity was a significant predictor of both whether RFO cases were reported at the hospital level (OR: 12.94; 95% CI: 7.38 to 22.68) and the number of reported cases throughout the period at the national level (Incidence Rate Ratio (IRR): 5.95; 95% CI: 1.11 to 31.82). CONCLUSIONS Our results raise concerns about the use of RFO incidence for comparing hospitals, countries and years. Utilising coding indices could be employed to mitigate the effects of coding intensity on RFO rates.
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Affiliation(s)
- David Schwappach
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Michael M Havranek
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Arora JS, Kim JK, Pakvasa M, Sayadi LR, Lem M, Widgerow AD, Leis AR. Microsurgical Needle Retention Does Not Cause Pain or Neurovascular Injury in a Rat Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5171. [PMID: 37547344 PMCID: PMC10402969 DOI: 10.1097/gox.0000000000005171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023]
Abstract
Approximately 20% of retained foreign bodies are surgical needles. Retained macro-needles may become symptomatic, but the effect of microsurgical needles is uncertain. We present the first animal model to simulate microsurgical needle retention. Given a lack of reported adverse outcomes associated with macro-needles and a smaller cutting area of microsurgical needles, we hypothesized that microsurgical needles in rats would not cause changes in health or neurovascular compromise. Methods Male Sprague-Dawley rats (x̄ weight: 288.9 g) were implanted with a single, 9.0 needle (n = 8) or 8.0 needle (n = 8) orthogonal to the right femoral vessels and sutured in place. A control group (n = 8) underwent sham surgery. Weekly, a cumulative health score evaluating body weight, body condition score, physical appearance, and behavior for each rat was determined. Infrared thermography (°C, FLIR one) of each hindlimb and the difference was obtained on postoperative days 15, 30, 60, and 90. On day 90, animals were euthanatized, hindlimbs were imaged via fluoroscopy, and needles were explanted. Results The mean, cumulative health score for all cohorts at each weekly timepoint was 0. The mean temperature difference was not significantly different on postoperative days 15 (P = 0.54), 30 (P = 0.97), 60 (P = 0.29), or 90 (P = 0.09). In seven of eight rats, 8.0 needles were recovered and visualized on fluoroscopy. In six of eight rats, 9.0 needles were recovered, but 0/8 needles were visualized on fluoroscopy. Conclusions Microsurgical needle retention near neurovascular structures may be benign, and imaging for needles smaller than 8.0 may be futile. Further studies should explore microsurgical needle retention potentially through larger animal models.
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Affiliation(s)
- Jagmeet S. Arora
- From the School of Medicine, University of California Irvine, Orange, Calif
| | | | - Mikhail Pakvasa
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Lohrasb R. Sayadi
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Melinda Lem
- From the School of Medicine, University of California Irvine, Orange, Calif
| | - Alan D. Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California Irvine, Orange, Calif
| | - Amber R. Leis
- Department of Plastic Surgery, University of California Irvine, Orange, Calif
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Schwappach D, Pfeiffer Y. Root causes and preventability of unintentionally retained foreign objects after surgery: a national expert survey from Switzerland. Patient Saf Surg 2023; 17:15. [PMID: 37296424 DOI: 10.1186/s13037-023-00366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Retained foreign objects (RFO) after surgery are rare, serious patient safety events. In international comparisons based on routine data, Switzerland had remarkably high RFO rates. The objectives of this study were to 1) explore national key stakeholders' views on RFO as a safety problem, its preventability and need for action in Switzerland; and 2) to assess their interpretation of Switzerland's RFO incidence compared to other countries. METHODS A semi-structured expert survey was conducted among national key representatives, including clinician experts, patient advocates, health administration representatives and other relevant stakeholders (n = 21). Data were coded and analyzed to generate themes related to the study questions following a deductive approach. RESULTS Experts in this study unequivocally emphasized the tragedy for individual patients affected by RFOs. Productivity pressure and the strong economization of operating rooms were perceived as detrimental to safety culture, which was seen as essential for RFO prevention, specifically by those working in the OR. RFOs were seen as "maximally minimizable" but not completely preventable. There was strong agreement that within country differences in RFO risk between Swiss hospitals existed. On the systems level and compared to other safety issues, RFO were having less urgency for most experts. The international comparison of RFO incidences raised serious skepticism across all groups of experts. The validity of the data was questioned and the dominant interpretation of Switzerland's high RFO incidence compared to other countries was a "reporting artifact" based on high coding quality in Swiss hospitals. While most experts thought that the published RFO incidence warrants in-depth analysis of the data, there was little agreement about who's role it was to initiate any further activities. CONCLUSIONS This investigation offers valuable insights into the perspectives of significant stakeholders concerning RFOs, their root causes, and preventability. The findings demonstrate how international comparative safety data are perceived, interpreted, and utilized by national experts to derive conclusive insights.
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Affiliation(s)
- David Schwappach
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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Polaskova M, Sedlacek T, Polasek Z, Filip P. Modification of Polyvinyl Chloride Composites for Radiographic Detection of Polyvinyl Chloride Retained Surgical Items. Polymers (Basel) 2023; 15:polym15030587. [PMID: 36771887 PMCID: PMC9919178 DOI: 10.3390/polym15030587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
The ever-present risk of surgical items being retained represents a real medical peril for the patient and potential liability issues for medical staff. Radiofrequency scanning technology is a very good means to substantially reduce such accidents. Radiolucent medical-grade polyvinyl chloride (PVC) used for the production of medical items is filled with radiopaque agents to enable X-ray visibility. The present study proves the suitability of bismuth oxychloride (BiOCl) and documents its advantages over the classical radiopaque agent barium sulfate (BaSO4). An addition of BiOCl exhibits excellent chemical and physical stability (no leaching, thermo-mechanical properties) and good dispersibility within the PVC matrix. As documented, using half the quantity of BiOCl compared to BaSO4 will provide a very good result. The conclusions are based on the methods of rotational rheometry, scanning electron microscopy, dynamic mechanical analysis, atomic absorption spectroscopy, and the verification of zero leaching of BiOCl out of a PVC matrix. X-ray images of the studied materials are presented, and an optimal concentration of BiOCl is evaluated.
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Affiliation(s)
- Martina Polaskova
- Centre of Polymer Systems, Tomas Bata University in Zlín, Trida Tomase Bati 5678, 760 01 Zlín, Czech Republic
| | - Tomas Sedlacek
- Centre of Polymer Systems, Tomas Bata University in Zlín, Trida Tomase Bati 5678, 760 01 Zlín, Czech Republic
- Correspondence: (T.S.); (P.F.)
| | - Zdenek Polasek
- Department of Food Technology, Faculty of Technology, Tomas Bata University in Zlín, Vavreckova 275, 760 01 Zlín, Czech Republic
| | - Petr Filip
- Institute of Hydrodynamics, Czech Academy of Sciences, Pod Patankou 5, 166 12 Prague, Czech Republic
- Correspondence: (T.S.); (P.F.)
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