Factors Associated With Retained Foreign Bodies Following Major Operations

BACKGROUND

Retained surgical foreign bodies (RFB) are associated with inferior clinical and financial outcomes. The present work examined a nationally representative sample of all major operations to identify factors associated with RFB.

STUDY DESIGN

The 2005-2017 National Inpatient Sample was used to identify adults undergoing cardiac, neurosurgical, orthopedic, genitourinary, gastrointestinal, vascular, and thoracic operations. International Classifications of Diseases 9th-10th Revisions diagnosis codes were used to identify instances of RFB.

RESULTS

Of an estimated 71,445,042 hospitalizations, .02% had a diagnosis of RFB, with decreasing incidence from .03 to .02% over the study period (NPtrend < .001). Relative to vascular operations, gastrointestinal (adjusted odds ratio [AOR] 2.12), thoracic (AOR 1.80), and multi-cavity (AOR 2.17) were associated with greater odds of RFB. Laparoscopic approach (AOR .33) and trauma-associated admission (AOR .52, all P < .001) were associated with reduced odds of RFB. Despite similar mortality, RFB was associated with increased odds of pulmonary infection (AOR 1.62), sepsis (AOR 1.26), and wound infection (AOR 5.15), as well as a 2.3-day increment in length of stay and $7700 in hospitalization costs (all P < .001).

CONCLUSION

The development of novel mitigation strategies may reduce the incidence of RFB in high-risk populations, such as those undergoing gastrointestinal, thoracic, and multi-cavity operations.

Gossypiboma - A Nightmare for Surgeon: A Rare Case with Review of Literature

Gossypiboma is an uncommon but avoidable condition, which is mostly asymptomatic initially and difficult to diagnose but can cause serious postoperative complications. It is a mass lesion due to surgical sponge or swab if retained in the body after the surgery. Gossypiboma has a vague presentation, and it is difficult to diagnose. In patients with a prior history of surgery having soft-tissue masses or localized pain abdomen, gossypiboma should be included in the differential diagnosis. We are reporting a case of a 33-year-old woman referred to our center with a complaint of vague abdominal pain, mild distension for the past 7 days, and discharge from the stitch line for the past 1 day. After investigation, diagnosis of gossypiboma was made and an exploratory laparotomy was performed to remove the retained surgical mop.

SURGICAL MANAGEMENT OF A PENETRATING BRAIN WOUND AND ASSOCIATED PERFORATING OCULAR INJURY CAUSED BY A LOW-VELOCITY SHARP METALLIC OBJECT: A CASE REPORT AND LITERATURE REVIEW

Penetrating traumatic brain injury accompanied by perforating ocular injury caused by low-velocity foreign bodies is a life-threatening condition, a surgical emergency and a major challenge in surgical practice, representing a severe subtype of non-missile traumatic brain injury, which is a relatively rare pathology among civilians. Optimal management of such an injury remains controversial, requiring full understanding of its pathophysiology and a multidisciplinary expert approach. Herein, we report a case of penetrating brain and associated perforating eye injury and discuss relevant literature providing further insight into this demanding complex multi-organ injury. We present a case of 39-year-old male patient with transorbital penetrating brain and perforating ocular injury undergoing emergency surgery to remove a retained sharp metallic object from the left parietal lobe. Following appropriate and urgent diagnostics, a decompressive left-sided fronto-temporo-parietal craniectomy was immediately performed. A retained sharp metallic object (a slice of a round saw) was successfully removed, while primary left globe repair and palpebral and fornix reconstruction were performed afterwards by an ophthalmologist. A prophylactic administration of broad-spectrum antibiotics was applied to prevent infectious complications. Early postoperative recovery was uneventful. The patient was discharged on day 45 post-injury having moderate right-sided motor weakness, ipsilateral facial nerve central palsy, and light motoric dysphasia. The vision to his left eye was completely and permanently lost. In conclusion, management of non-missile transorbital penetrating brain injury can be satisfactory when proper clinical and radiologic evaluation, and amply, less radical surgical approach is performed early. A multidisciplinary routine is a prerequisite in achieving a favorable management outcome.

The Wandering Knife: A Case Report

Stab injuries to the abdomen have become a common occurrence, though retained objects are rare. A 22-year-old male presented with a left lower abdominal discomfort the next day after having a stab in the right hypochondrium. He was hemodynamically stable, with no signs of peritonitis. Abdominal X-ray revealed a 15 cm long knife blade in the left lower abdomen. He underwent a laparotomy for the removal of the knife blade located inside the peritoneal cavity in his left iliac region without any injury to the surrounding viscera.

Anterioposterior Views Coupled With Lateral Views Are the Best for the Intraoperative Radiographic Detection of Retained Surgical Sponges

INTRODUCTION

A retained sponge after spine surgery can cause serious medical complications and medicolegal problems. Intraoperative radiographs are commonly used to detect it. This study evaluated intraoperative radiographs under routine clinical conditions that most spine surgeons experience to detect retained sponges.

METHODS

In this prospective randomized clinical trial, two patient groups undergoing open posterior lumbar surgery were studied. In one, a sponge was intentionally present; in the other, none was present. Standard intraoperative lateral (LAT) and anteroposterior (AP) radiographs were acquired before closing. Radiographs were analyzed for sensitivity, specificity, inter- and intraobserver reliability for three viewing conditions: one LAT radiograph versus one AP radiograph versus one LAT and one AP X-ray (LAT+AP).

RESULTS

A total of 111 patients were included. Accuracy, interobserver reliability, and intraobserver reliability were best for LAT+AP (80%, 96%, and 96%, respectively). Sensitivity was best for LAT+AP (87%) and specificity was best for LAT (95%). Positive predictive value was best for LAT (94%); negative predictive value was best for LAT+AP (88%). The probability of being right is better for female sex (odds ratio 1.6), younger age (odds ratio 1.02), and higher BMI (odds ratio 1.06).

CONCLUSIONS

We recommend AP with LAT images rather than either an AP or a LAT image alone.

A Decade-Long Delay in Presentation of Retained Foreign Bodies as Sequelae of Ballistic Injuries: A Report of Two Cases

In many regions of the world, ballistic injuries are on the decline. With the reduced incidence of encountering these injuries, there is no general consensus on how to deal with ballistic fragments. Constant research in material science has led to the evolution of materials utilised in ballistics production. However, there has not been enough research into the effect of long-term exposure of the human body to these materials. Ballistic fragments, when asymptomatic and not in the vicinity of vital structures, are often thought to be innocuous in nature. Earlier concepts stated that these metallic fragments were encapsulated in the body by fibrosis and remained inert substances. However, the emerging evidence suggests that these retained ballistic fragments are more alike to ticking time bombs than the inert materials they were earlier thought to be. Side effects of long-term exposure to these materials can lead to not just systemic toxicity due to chronic metallic exposure but may even have carcinogenic effects. This article reports two cases of retained ballistic fragments that presented in a delayed fashion due to their prior asymptomatic status coupled with inadequate investigation and intervention. It also discusses the issues associated with the retention of these fragments, especially in cases where adequate information is not available regarding the nature and composition of the retained materials or their interactions with the human body on long-term exposure.