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Wodoslawsky S, Mossayebi MH, Alleyne G, Al-Kouatly HB. Management of a Retained Broken Suture Needle During Cerclage Placement. Obstet Gynecol 2023; 142:1241-1243. [PMID: 37562036 DOI: 10.1097/aog.0000000000005316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Broken suture needles with unintentional foreign body retention are an uncommon occurrence during obstetric procedures. Few reports exist in the literature of cases in pregnant patients. We report a case with the pregnancy management of a broken needle during cerclage placement that was retained in the cervix until repeat cesarean delivery. CASE A 36-year-old woman, gravida 12 para 5, presented at 13 weeks of gestation for a history-indicated cerclage. The suture needle broke during the cerclage procedure, leaving a 35-mm needle fragment inside the cervical stroma between the 11 and 2 o'clock position that could not be recovered after multiple attempts. The procedure continued without needle recovery. Intraoperative pelvic X-ray was performed, demonstrating the retained fragment. No further attempts at recovery were made during the pregnancy, and a plan was made to proceed with removal at the patient's repeat cesarean delivery. The patient presented in labor at 32 1/7 weeks of gestation and underwent an uncomplicated cesarean delivery. The retained needle was subsequently removed after manual palpation of the fragment transvaginally. CONCLUSION Retained broken suture needles during obstetric procedures require careful management decisions in pregnant patients. Retention of a needle fragment until delivery may be considered if risks of removal outweigh the anticipated benefits.
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Affiliation(s)
- Sascha Wodoslawsky
- Sidney Kimmel Medical College and the Department of Obstetrics and Gynecology and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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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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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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Kang HS, Khoraki J, Gie J, Duval D, Haynes S, Siev M, Shah J, Kim F, Mangino M, Procter L, Autorino R, Weprin S. Multiphase preclinical assessment of a novel device to locate unintentionally retained surgical sharps: a proof-of-concept study. Patient Saf Surg 2023; 17:10. [PMID: 37101230 PMCID: PMC10131432 DOI: 10.1186/s13037-023-00359-8] [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: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
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.
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Affiliation(s)
- Hae Sung Kang
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Jad Khoraki
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Jessie Gie
- Department of Urology, Stanford Health, Palo Alto, CA, USA
| | - Dielle Duval
- Department of Urology, Graves Gilbert Clinic, Bowling Green, KY, USA
| | - Susan Haynes
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Michael Siev
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jay Shah
- Department of Urology, Stanford Health, Palo Alto, CA, USA
| | - Fernando Kim
- Department of Urology, University of Colorado, Denver, CO, USA
| | - Martin Mangino
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Levi Procter
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Riccardo Autorino
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Samuel Weprin
- New Jersey Urology, Summit Health, Cherry Hill, NJ, USA.
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Braga M, Paixão H, Caldeira JP. Incidental gossypiboma on contrast enema study. Radiol Case Rep 2023; 18:1144-1146. [PMID: 36655005 PMCID: PMC9841347 DOI: 10.1016/j.radcr.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
This is a case report of a 50-year-old woman with HIV/HCV coinfection who was diagnosed with an HPV-related well-differentiated squamous cell carcinoma of the vulva. After undergoing modified radical vulvectomy and bilateral inguinofemoral lymphadenectomy, the patient developed a rectovaginal fistula and a diverting colostomy was placed. During a postoperative contrast enema study, a curvilinear hyperdense stripe was noted, representing the radiodense marker thread of a retained surgical sponge. This case report highlights the importance of awareness of this retained surgical item and its associated possible complications, as well as the importance of imaging modalities for diagnosis.
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Bai YF, Niu JQ, Zhang C, Wang W, Liu JZ. Computed Tomography and Magnetic Resonance Imaging Appearances of Abdomen and Pelvis Gossypibomas at the Varied Durations After Cesarean Section. Cureus 2021; 13:e18588. [PMID: 34765355 PMCID: PMC8575338 DOI: 10.7759/cureus.18588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/15/2022] Open
Abstract
The incidence of gossypiboma is considerably higher in open cavity surgeries, among which cesarean section ranks number one. However, it is difficult to diagnose abdomen or pelvic gossypibomas after cesarean section. We retrospectively analyzed the clinical and imaging data of three pathologically confirmed gossypiboma patients at varied durations after cesarean section. In case one, at four months after cesarean section, a gossypiboma near the small intestine caused fistula and intestinal obstruction. Soft tissue density lesion along the intestinal canal made the “segmental honeycomb sign" and "truncation" with metal markings on the edge on computed tomography (CT). Magnetic sensitivity artifacts were demonstrated as hypointensity on T1 weighted image (T1WI) and T2 weighted image (T2WI), while hyperintensity was seen on the diffusion weighted image (DWI). In case two, a gossypiboma in the peritoneal and intestinal space was revealed with MRI at 18 months after cesarean section. It was featured as a cystic and solid lesion, with "vortex like sign" and obvious ring enhancement on contrast-enhanced MRI scan. In case three, five years after cesarean section, a mass was palpated in the right middle and lower abdomen. MRI revealed a round mass of T1 hypointensity with mixed T2 signal, as well as swirling hypointensity in T2WI, T2WI-fat suppression (FS), and DWI. In CT and MRI examinations for suspected gossypiboma after cesarean section, "honeycomb sign" and "vortex like sign" are the characteristic appearances; gauze translocated into the intestine may show the "truncation sign". Accurate diagnosis is based on the surgery history, symptoms, and imaging features.
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Affiliation(s)
- Yu-Feng Bai
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Juan-Qin Niu
- Department of Radiology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, CHN
| | - Chao Zhang
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
| | - Wen Wang
- Department of Radiology, Fourth Military Medical University, Shaanxi, CHN
| | - Jing-Zhong Liu
- Department of Radiology, The 944th Hospital of Joint Logistics Support Force of People's Liberation Army, Jiuquan, CHN
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Weprin S, Crocerossa F, Meyer D, Maddra K, Valancy D, Osardu R, Kang HS, Moore RH, Carbonara U, J Kim F, Autorino R. Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review. Patient Saf Surg 2021; 15:24. [PMID: 34253246 PMCID: PMC8276389 DOI: 10.1186/s13037-021-00297-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Samuel Weprin
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Dielle Meyer
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Kaitlyn Maddra
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - David Valancy
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Reginald Osardu
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Hae Sung Kang
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Robert H Moore
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA
- Dept of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Fernando J Kim
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Center, Colorado, Denver, USA
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA.
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Weprin SA, Meyer D, Li R, Carbonara U, Crocerossa F, Kim FJ, Autorino R, Speich JE, Klausner AP. Incidence and OR team awareness of "near-miss" and retained surgical sharps: a national survey on United States operating rooms. Patient Saf Surg 2021; 15:14. [PMID: 33812376 PMCID: PMC8019169 DOI: 10.1186/s13037-021-00287-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Samuel A Weprin
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Dielle Meyer
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Rui Li
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Umberto Carbonara
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Fabio Crocerossa
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, USA
| | - Fernando J Kim
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Campus, Denver, USA.
| | - Riccardo Autorino
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Campus, Denver, USA
| | - John E Speich
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Campus, Denver, USA
| | - Adam P Klausner
- Division of Urology Denver Health Medical Center and University of Colorado Anschutz Medical Campus, Denver, USA
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Mejri A, Arfaoui K, Aloui B, Yaakoubi J. Gossypiboma: the failure of a successful intervention. Pan Afr Med J 2020; 36:335. [PMID: 33193988 PMCID: PMC7603822 DOI: 10.11604/pamj.2020.36.335.25464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022] Open
Abstract
If successful surgery is the primary quest of any surgeon, unintentionally leaving behind surgical items in the operative field remains his most feared obsession. This rare but dramatic accident can lead to potentially fatal complications and turn both lives of the surgeon and the patient upside down. We present the case of a 29-year-old female patient who presented to the ER with three days history of severe diffuse abdominal pain associated with fever, biological inflammatory syndrome and well-tolerated iron deficiency anaemia. She had no past medical history except for a lower segment cesarean section 5 months ago. Abdominal MRI allowed the diagnosis of two gossypibomas responsible for two intra-abdominal collections. An emergency laparotomy allowed the removal of these foreign bodies and the management of their serious complications of intestinal perforation by the construction of a double intestinal stoma. The patient made a post-operative uneventful recovery. This observation emphasizes the need to raise the practitioner´s awareness about this differential diagnosis in every case of any poorly localized abdominal pain occurring after surgery.
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Affiliation(s)
- Atef Mejri
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Khaoula Arfaoui
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Badreddine Aloui
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
| | - Jasser Yaakoubi
- General Surgery Department, Regional Hospital of Jendouba, Jendouba, Tunisia
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