The recurring problem of retained swabs and instruments

Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges

BACKGROUND

We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting.

STUDY DESIGN

A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected.

RESULTS

Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software.

CONCLUSIONS

The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

Prolonged retention of gauze sponge resulting in ileocolic fistula, a rare complication following cesarean section; case report

INTRODUCTION AND IMPORTANCE

Retained gauze sponge is a medical legal issue with significant clinical implications with catastrophic complications. We report a case of a female who presented with chronic right iliac fossa pain only to be found to have a retained gauze sponge causing bowel fistulisation. We describe our experience on diagnostic formulation and work up and subsequent operative intervention.

CASE PRESENTATION

We present the case of a 37-year-old female patient who presented to the outpatient surgical department with symptoms of chronic right iliac fossa pain with a history of cesarean section 2 years prior. A computed tomography scan revealed an inflammatory mass and operative exploration revealed a retained gauze sponge causing a fistula between the terminal ileum and caecum. Underwent a right hemicolectomy with an uneventful postoperative period.

CLINICAL DISCUSSION

Retained gauzes can lead to a spectrum of complications including fistulisation presenting with vague non-specific abdominal symptoms. The subtle presentation challenges the clinician to consider the possibility of retained foreign bodies in patient with history of abdominal surgeries. This emphasizes the importance of policies enforcing swab count as a simple retained gauze led to catastrophic complication and ultimately a right hemicolectomy.

CONCLUSION

This case report presents a complex and instructive clinical scenario, emphasizing the challenges of diagnosing atypical presentations of retained foreign bodies, the critical importance of surgical counting protocols, and the implications for patient safety and quality of care.

Identifying a list of healthcare 'never events' to effect system change: a systematic review and narrative synthesis

BACKGROUND

Never events (NEs) are patient safety incidents that are preventable and so serious they should never happen. To reduce NEs, several frameworks have been introduced over the past two decades; however, NEs and their harms continue to occur. These frameworks have varying events, terminology and preventability, which hinders collaboration. This systematic review aims to identify the most serious and preventable events for targeted improvement efforts by answering the following questions: Which patient safety events are most frequently classified as never events? Which ones are most commonly described as entirely preventable?

METHODS

For this narrative synthesis systematic review we searched Medline, Embase, PsycINFO, Cochrane Central and CINAHL for articles published from 1 January 2001 to 27 October 2021. We included papers of any study design or article type (excluding press releases/announcements) that listed NEs or an existing NE framework.

RESULTS

Our analyses included 367 reports identifying 125 unique NEs. Those most frequently reported were surgery on the wrong body part, wrong surgical procedure, unintentionally retained foreign objects and surgery on the wrong patient. Researchers classified 19.4% of NEs as 'wholly preventable'. Those most included in this category were surgery on the wrong body part or patient, wrong surgical procedure, improper administration of a potassium-containing solution and wrong-route administration of medication (excluding chemotherapy).

CONCLUSIONS

To improve collaboration and facilitate learning from errors, we need a single list that focuses on the most preventable and serious NEs. Our review shows that surgery on the wrong body part or patient, or the wrong surgical procedure best meet these criteria.

Multiphase preclinical assessment of a novel device to locate unintentionally retained surgical sharps: a proof-of-concept study

BACKGROUND

Retained surgical sharps (RSS) is a "never event" that is preventable but may still occur despite of correct count and negative X-ray. This study assesses the feasibility of a novel device ("Melzi Sharps Finder®" or MSF) in effective detection of RSS.

METHODS

The first study consisted of determination of the presence of RSS or identification of RSS in an ex-vivo model (a container with hay in a laparoscopic trainer box). The second study consisted of determining presence of RSS in an in-vivo model (laparoscopy in live adult Yorkshire pigs) with 3 groups: C-arm, C-arm with MSF and MSF. The third study used similar apparatus though with laparotomy and included 2 groups: manual search and MSF.

RESULTS

In the first study, the MSF group had a higher rate of identification of a needle and decreased time to locate a needle versus control (98.1% vs. 22.0%, p < 0.001; 1.64 min ± 1.12vs. 3.34 min ± 1.28, p < 0.001). It also had increased accuracy of determining the presence of a needle and decreased time to reach this decision (100% vs. 58.8%, p < 0.001; 1.69 min ± 1.43 vs. 4.89 min ± 0.63, p < 0.001). In-the second study, the accuracy of determining the presence of a needle and time to reach this decision were comparable in each group (88.9% vs. 100% vs. 84.5%, p < 0.49; 2.2 min ± 2.2 vs. 2.7 min ± 2.1vs. 2.8 min ± 1.7, p = 0.68). In the third study, MSF group had higher accuracy in determining the presence of a needle and decreased time to reach this decision than the control (97.0% vs. 46.7%, p < 0.001; 2.0 min ± 1.5 vs. 3.9 min ± 1.4; p < 0.001). Multivariable analysis showed that MSF use was independently associated with an accurate determination of the presence of a needle (OR 12.1, p < 0.001).

CONCLUSIONS

The use of MSF in this study's RSS models facilitated the determination of presence and localization of RSS as shown by the increased rate of identification of a needle, decreased time to identification and higher accuracy in determining the presence of a needle. This device may be used in conjunction with radiography as it gives live visual and auditory feedback for users during the search for RSS.

A deep learning model based on fusion images of chest radiography and X-ray sponge images supports human visual characteristics of retained surgical items detection

PURPOSE

Although a novel deep learning software was proposed using post-processed images obtained by the fusion between X-ray images of normal post-operative radiography and surgical sponge, the association of the retained surgical item detectability with human visual evaluation has not been sufficiently examined. In this study, we investigated the association of retained surgical item detectability between deep learning and human subjective evaluation.

METHODS

A deep learning model was constructed from 2987 training images and 1298 validation images, which were obtained from post-processing of the image fusion between X-ray images of normal post-operative radiography and surgical sponge. Then, another 800 images were used, i.e., 400 with and 400 without surgical sponge. The detection characteristics of retained sponges between the model and a general observer with 10-year clinical experience were analyzed using the receiver operator characteristics.

RESULTS

The following values from the deep learning model and observer were, respectively, derived: Cutoff values of probability were 0.37 and 0.45; areas under the curves were 0.87 and 0.76; sensitivity values were 85% and 61%; and specificity values were 73% and 92%.

CONCLUSION

For the detection of surgical sponges, we concluded that the deep learning model has higher sensitivity, while the human observer has higher specificity. These characteristics indicate that the deep learning system that is complementary to humans could support the clinical workflow in operation rooms for prevention of retained surgical items.

Influence of Perioperative Practice on Cognitive Function of Scrub Nurses: A Cross-Sequential Study

BACKGROUND

The operating room is a sophisticated, dynamic environment, with advanced technology. The goal of our study is to evaluate the effect of peri-operative practice on the cognitive functions of scrub nurses.

METHOD

This study included a total of 75 scrub nurses. The d2 Test of Attention was used for evaluation of cognitive function. The test was conducted with participants on three different working shifts.

RESULTS

A significant difference was found between overall mean values for total number of items processed, number of errors, total number of items processed minus number of errors, and concentration performance scores for the posttest compared with the pretest.

CONCLUSION

Perioperative practice has a significantly positive effect on cognitive function of scrub nurses, although this positive effect has a downward trend with increasing age as well as increasing workload. [J Contin Educ Nurs. 2021;52(12):565-574.].

Novel Computer-Aided Diagnosis Software for the Prevention of Retained Surgical Items

BACKGROUND

Retained surgical items are a serious human error. Surgical sponges account for 70% of retained surgical items. To prevent retained surgical sponges, it is important to establish a system that can identify errors and avoid the occurrence of adverse events. To date, no computer-aided diagnosis software specialized for detecting retained surgical sponges has been reported. We developed a software program that enables easy and effective computer-aided diagnosis of retained surgical sponges with high sensitivity and specificity using the technique of deep learning, a subfield of artificial intelligence.

STUDY DESIGN

In this study, we developed the software by training it through deep learning using a dataset and then validating the software. The dataset consisted of a training set and validation set. We created composite x-rays consisting of normal postoperative x-rays and surgical sponge x-rays for a training set (n = 4,554) and a validation set (n = 470). Phantom x-rays (n = 12) were prepared for software validation. X-rays obtained with surgical sponges inserted into cadavers were used for validation purposes (formalin: Thiel's method = 252:117). In addition, postoperative x-rays without retained surgical sponges were used for the validation of software performance to determine false-positive rates. Sensitivity, specificity, and false positives per image were calculated.

RESULTS

In the phantom x-rays, both the sensitivity and specificity in software image interpretation were 100%. The software achieved 97.7% sensitivity and 83.8% specificity in the composite x-rays. In the normal postoperative x-rays, 86.6% specificity was achieved. In reading the cadaveric x-rays, the software attained both sensitivity and specificity of >90%.

CONCLUSIONS

Software with high sensitivity for diagnosis of retained surgical sponges was developed successfully.

Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review

BACKGROUND

A retained surgical item (RSI) is defined as a never-event and can have drastic consequences on patient, provider, and hospital. However, despite increased efforts, RSI events remain the number one sentinel event each year. Hard foreign bodies (e.g. surgical sharps) have experienced a relative increase in total RSI events over the past decade. Despite this, there is a lack of literature directed towards this category of RSI event. Here we provide a systematic review that focuses on hard RSIs and their unique challenges, impact, and strategies for prevention and management.

METHODS

Multiple systematic reviews on hard RSI events were performed and reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Database searches were limited to the last 10 years and included surgical "sharps," a term encompassing needles, blades, instruments, wires, and fragments. Separate systematic review was performed for each subset of "sharps". Reviewers applied reciprocal synthesis and refutational synthesis to summarize the evidence and create a qualitative overview.

RESULTS

Increased vigilance and improved counting are not enough to eliminate hard RSI events. The accurate reporting of all RSI events and near miss events is a critical step in determining ways to prevent RSI events. The implementation of new technologies, such as barcode or RFID labelling, has been shown to improve patient safety, patient outcomes, and to reduce costs associated with retained soft items, while magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of metallic RSI recovery.

CONCLUSION

The entire healthcare system is negatively impacted by a RSI event. A proactive multimodal approach that focuses on improving team communication and institutional support system, standardizing reports and implementing new technologies is the most effective way to improve the management and prevention of RSI events.

Incidence and OR team awareness of "near-miss" and retained surgical sharps: a national survey on United States operating rooms

INTRODUCTION

A retained surgical sharp (RSS) is a never event and defined as a lost sharp (needle, blade, instrument, guidewire, metal fragment) that is not recovered prior to the patient leaving the operating room. A "near-miss" sharp (NMS) is an intraoperative event where there is a lost surgical sharp that is recovered prior to the patient leaving the operating room. With underreporting of such incidents, it is unrealistic to expect aggressive development of new prevention and detection strategies. Moreover, awareness about the issue of "near-miss" or retained surgical sharps remains limited. The aim of this large-scale national survey-based study was to estimate the incidence of these events and to identify the challenges surrounding the use of surgical sharps in daily practice.

METHODS

We hypothesized that there was a larger number of RSS and NMS events than what was being reported. We survived the different OR team members to determine if there would be discordance in reported incidence between groups and to also evaluate for user bias. An electronic survey was distributed to OR staff between December 2019 and April 2020. Respondents included those practicing within the United States from both private and academic institutions. Participants were initially obtained by designating three points of contact who identified participants at their respective academic institutions and while attending specialty specific medical conferences. Together, these efforts totaled 197 responses. To increase the number of respondents, additional emails were sent to online member registries. Approximately 2650 emails were sent resulting in an additional 250 responses (9.4% response rate). No follow up reminders were sent. In total, there were 447 survey responses, in which 411 were used for further analysis. Thirty-six responses were removed due to incomplete respondent data. Those who did not meet the definition of one of the three categories of respondents were also excluded. The 411 were then categorized by group to include 94 (22.9%) from anesthesiologist, 132 (32.1%) from resident/fellow/attending surgeon and 185 (45%) from surgical nurse and technologist.

SURVEY

The survey was anonymous. Participants were asked to answer three demographic questions as well as eight questions related to their personal perception of NMS and RSS (Fig. 1). Demographic questions were asked with care to ensure no identifiable information was obtained and therefore unable to be traced back to a specific respondent or institution. Perception questions 4-6 and 11 were designed to understand the incidence of various sharp events (e.g. lost, retained, miscounted). Questions 7 and 10 were dedicated to understanding time spent managing sharps and questions 8 and 9 were dedicated to understanding the use x-ray and its effectiveness.

RESULTS

Overall, most of each respondent group reported 1-5 lost sharp events over the last year. Roughly 20% of surgeons believed they never had a miscounted sharp over the last year, where only 5.3% of anesthesiologist reported the same (p = 0.002). Each group agreed that roughly 4 lost events occur every 1000 surgeries, but a significant difference was found between the three groups regarding the number of lost sharps not recovered per 10,000 surgeries with anesthesiologist, surgeon and nurse/technologist groups estimating 2.37, 2.56 and 2.94 respectively (p = 0.001). All groups noted x-ray to offer poor effectiveness at 26-50% with 31-40 min added for each time x-ray was used. More than half (56.8%) of surgeons reported using x-ray 100% of the time when managing a lost sharp whereas anesthesiologists and nurses/technologists believe it is closer to 1/3 of the time. An average of 21-30 min is spent managing each NMS, making a lost sharp event result in up to 70 min of added OR time.

CONCLUSIONS

"Near-miss" and RSS are more prevalent than what is reported in current literature. Surgeons perceive a higher rate of success in retrieving the RSS when compared to anesthesiologists and OR nurses/technologists. We recognize several challenges surrounding "near-miss" and never events as contributing factors to their underreported nature and the higher degree of surgeon recall bias associated with these events. Additionally, we highlight that current methods for prevention are costly in time and resources without improvement in patient safety. As NMS and RSS have significant health system implications, a strong understanding of these implications is important as we strive to improve patient safety.

A qualitative content analysis of retained surgical items: learning from root cause analysis investigations

OBJECTIVE

To describe incidents of retained surgical items, including their characteristics and the circumstances in which they occur.

DESIGN

A qualitative content analysis of root cause analysis investigation reports.

SETTING

Public health services in Victoria, Australia, 2010-2015.

PARTICIPANTS

Incidents of retained surgical items as described by 31 root cause analysis investigation reports.

MAIN OUTCOME MEASURE(S)

The type of retained surgical item, the length of time between the item being retained and detected and qualitative descriptors of the contributing factors and the circumstances in which the retained surgical items occurred.

RESULTS

Surgical packs, drain tubes and vascular devices comprised 68% (21/31) of the retained surgical items. Nearly one-quarter of the retained surgical items were detected either immediately in the post-operative period or on the day of the procedure (7/31). However, about one-sixth (5/31) were only detected after 6 months, with the longest period being 18 months. Contributing factors included complex or multistage surgery; the use of packs not specific to the purpose of the surgery; and design features of the surgical items.

CONCLUSION

Retained drains occurred in the post-operative phase where surgical counts are not applicable and clinician situational awareness may not be as great. Root cause analysis investigation reports can be a valuable means of characterizing infrequently occurring adverse events such as retained surgical items. They may detect incidents that are not detected by other data collections and can inform the design enhancements and development of technologies to reduce the impact of retained surgical items.

Gynecology healthcare professionals towards safety procedures in operation rooms aiming to enhanced quality of medical services in Greece

PURPOSE

The purpose of this paper is to investigate the attitudes of healthcare professionals in Greece toward safety practices in gynecological Operation Rooms (ORs).

DESIGN/METHODOLOGY/APPROACH

An anonymous self-administered questionnaire was distributed to surgical personnel asking for opinions on safety practices during vaginal deliveries (VDs) and gynecological operations (e.g. sponge/suture counting, counting documentation, etc.). The study took place in Hippokration Hospital of Thessaloniki including 227 participants. The team assessed and statistically analyzed the questionnaires.

FINDINGS

Attitude toward surgical counts and counting documentation, awareness of existence and/or implementation in their workplace of other surgical safety objectives (e.g. WHO safety control list) was assessed. In total, 85.2 percent considered that surgical counting after VDs is essential and 84.9 percent admitted doing so, while far less reported counting documentation as a common practice in their workplace and admitted doing so themselves (50.5/63.3 percent). Furthermore, while 86.5 percent considered a documented protocol as necessary, only 53.9 percent admitted its implementation in their workplace. Remarkably, 53.1 percent were unaware of the WHO safety control list for gynecological surgeries.

ORIGINALITY/VALUE

Most Greek healthcare professionals are well aware of the significance of surgical counting and counting documentation in gynecology ORs. However, specific tasks and assignments are unclear to them. Greek healthcare professionals consider surgical safety measures as important but there is a critical gap in knowledge when it comes to responsibilities and standardized processes during implementation. More effective implementation and increased personnel awareness of the surgical safety protocols and international guidelines are necessary for enhanced quality of surgical safety in Greece.

Intravesical gossypiboma: our experience and the need for stringent checklist and training!

We present our experience of two cases: one of a 28-year-old male patient who presented with recurrent episodes of urinary tract infection (UTI) with passage of pus flakes in urine and a history of open cystolithotomy about 10 months ago. The second patient was a 26-year-old woman who underwent bladder exploration for a retained Double-J stent about 10 months ago and presented with recurrent UTI. The first case was treated with open surgery and in the second case, the gauze piece was retrieved endoscopically.

Retained surgical needle and gauze after cesarean section and adnexectomy: a case report and literature review

Although the incidence of retained surgical items (RSIs) is low, it is nevertheless an important preventable cause of patient injury that can ultimately lead to the patient's death and to subsequent high medical and legal costs. Unintentional RSI is the cause of 70% of re-interventions, with a morbidity of 80% and mortality of 35%. The most common RSIs are sponges or gauze (gossypiboma or textiloma), while retained surgical instruments and needles are rare. Perioperative counting of equipment and materials is the most common method of screening for RSIs, while a diagnosis can later be confirmed by the clinical appearance and by imaging studies. We present a rare case of a 43-year-old patient who was admitted to our hospital because of two retained needles following a cesarean section, despite several subsequent laparotomies. One needle had been removed previously, but in addition to the remaining needle, we also removed a retained gauze. The diagnosis of RSIs is extremely important, and safe surgical practices including the addition of new imaging technologies should be encouraged to detect RSIs.

Improving communication at handover and transfer reduces retained swabs in maternity services

OBJECTIVE

To reduce the incidence of retained vaginal swabs and near misses.

STUDY DESIGN

A review of previous retained swab incidents and near misses in a large maternity unit identified handovers and transfers as a key point of vulnerability. Interventions were introduced to improve communication at handover from the delivery suite to theatre and from theatre to the high dependency unit. Process data was collected to monitor compliance. The outcome measures were the incidence of retained swab never events and the incidence of near misses. Chi-squared analysis was used to test the significance of the results.

RESULTS

For transfers from delivery suite to theatre, verbal handover significantly increased from 28.8% to 75.6% (p<0.0001), and written handover significantly increased from 4.4% to 62.9% (p<0.0001). There were 291 transfers to theatre post-intervention: in 88 (30.2%) of these transfers a vaginal swab was already in situ. In 70/88 (79.5%) of cases the presence of the swab was communicated to theatre staff in three ways (verbally, written and transfer of opened swab packets) according to the new policy. In the post-intervention period there were 56 women transferred from theatre to the high-dependency unit with a vaginal pack in situ: 52 (92.9%) of these women had a sticker in place serving as a constant reminder of the presence of the vaginal pack to staff. Following a baseline of four near misses in two months, there has been only one near miss in the 15 months since the interventions were implemented, (33.3% vs. 1.1%, p<0.0001). There have been no retained swab incidents since the project commenced.

CONCLUSIONS

Simple interventions to improve communication at handover and transfer can reduce the incidence of retained vaginal swabs and near misses. Further work is needed to raise the profile of swab counting in maternity settings: swab counting needs to be the responsibility of all disciplines, not just the responsibility of theatre staff.

Surgical sponge forgotten for nine years in the abdomen: A case report

•

Gossypiboma consist in retained surgical sponges are more usual than the reported.

•

A young patient nine years after cesarean section with abdominal pain and fever.

•

An abscess was diagnosed in the lower abdomen by CT.

•

During laparotomy, a sponge was extracted from a large abscess.

•

She had a normal post-operative course.

Introduction

Retained surgical sponge or other items in patients’ bodies happens more frequently than is reported. Healthcare personnel can forget to remove textile material or instruments during complicated, extended, or emergency surgery. In addition, changes in the operating team can influence the occurrence of such errors.

Presentation of case

We present a case with a symptomatic gossypiboma nine years after a previous cesarean section. A 34-year-old woman was admitted to the emergency room having experienced abdominal pain and fever for the previous month. An abdominal computed tomography revealed an abscess in the lower abdomen.

A laparotomy was performed, and a resection and block were carried out. A surgical sponge was extracted from an omental abscess.

Discussion

Surgical sponges are the most common foreign materials retained (70%) in the abdominal cavity because of their frequent usage and small size. Moreover, a blood-soaked sponge in a hemorrhagic abdomen can be difficult to distinguish from blood.

Conclusion

Whenever the accounting for material depends on humans, mistakes will continue to be committed.

A falsely correct sponge count was reported in 71.42% of cases [14]; therefore, a new count system must be developed for post-surgical situations.

Medicolegal consequences of thoracic gossypiboma: A case report

The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but it is associated with severe medical and legal consequences. The diagnosis can be missed despite radiological investigations. We report a case of a 15-year-old female who presented with fever, cough, dyspnea and hemoptysis. She had a history of hydatid cyst operation 2 years ago. Post-discharge follow up occurred for two years on hospital where hydatid cyst surgery had been done. Radiological investigations were inconclusive in detecting the retained sponge despite radiopaque marker. So gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as persistent respiratory symptoms after the operation.

Intestinal Obstruction and Ileocolic Fistula due to Intraluminal Migration of a Gossypiboma

Gossypiboma refers, as a term, to a retained surgical sponge. It is considered as a rare surgical complication which can occur despite precautions. We report a case of a 36-year-old woman who was admitted to our surgical department with symptoms of abdominal pain associated with episodes of nausea and vomiting that lasted for 2 months. Six months ago she had undergone a cesarean section in a private clinic. Computed tomography revealed a high-density mass occupying a portion of the intestinal lumen, which was reported as a “calcified parasite.” The patient was subjected to laparotomy. The intraoperative findings included signs of obstructive ileus and ileosigmoid fistula and a large sponge was found at the resected portion of the small intestine. Although gossypiboma is a rare entity, it should be included in the differential diagnosis.

Retained foreign bodies: risk and outcomes at the national level

BACKGROUND

Retained foreign bodies (RFB) after operative interventions are linked to an increased risk of morbidity and mortality, and represent a medico-legal liability. We aimed to identify associated risk factors and outcomes related to iatrogenic RFB in the United States.

STUDY DESIGN

A cross-sectional analysis was performed on all interventions that resulted in a secondary diagnosis of RFB in the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Comparative controls were randomly selected from patients who underwent similar procedures.

RESULTS

We identified 3,045 cases of RFB, and 12,592 controls were included. The majority of incidents, 968 (31.8%), were reported after gastrointestinal interventions. Risk of RFB was higher in teaching hospitals (odds ratio [OR] 1.31, 95% CI [1.19, 1.45], p < 0.001). For abdominopelvic procedures, patients admitted with traumatic injuries did not demonstrate a higher risk of RFB compared with electively admitted patients (OR 1.70, 95% CI [0.94, 3.07], p = 0.08). However, for procedures unrelated to abdominopelvic surgery, patients admitted for trauma had a lower risk (OR 0.62, 95% CI [0.50, 0.78], p < 0.001). Obesity (BMI ≥ 30 kg/m(2)) and older age (≥ 65 years) were significantly associated with a higher risk only for abdominopelvic procedures (p < 0.01 for both). Retained foreign bodies were associated with a higher average cost of health services ($26,678.00 ± $769.69 vs $12,648.00 ± $192.80, p < 0.001).

CONCLUSIONS

Retained foreign bodies have unfavorable and nationally tangible clinical and economic outcomes. The risk profile for RFB at the national level seems to demonstrate an association with demographic and clinical factors including nature of the procedure, type of admission, and trauma status. Teaching hospitals are associated with a higher risk. Targeted efforts toward identified high-risk populations are needed to avoid these morbid and costly complications.