Related Experiment Videos
Risk factors for retained instruments and sponges after surgery
Atul A Gawande1, David M Studdert, E John Orav
1Departments of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
The New England Journal of Medicine
|January 17, 2003
Summary
Surgical errors like retained foreign bodies are more common during emergency procedures, unexpected surgical changes, and in patients with higher body-mass index. Understanding these risk factors can help prevent future medical errors.
Area of Science:
- Medical error analysis
- Surgical patient safety
- Risk factor identification
Background:
- Medical errors, particularly retained foreign bodies, have poorly understood risk factors.
- A case-control study was conducted to identify specific risk factors for retained surgical items.
Purpose of the Study:
- To identify and quantify risk factors associated with retained foreign bodies in surgical patients.
- To analyze malpractice claims data to understand error patterns.
Main Methods:
- A case-control study analyzed medical records from malpractice claims (1985-2001) for retained surgical sponges or instruments.
- Cases of retained foreign bodies were matched with control patients undergoing similar procedures.
Main Results:
- The study included 54 cases and 235 controls. Retained foreign bodies occurred more frequently in emergency surgeries (33% vs 7%) and with unexpected procedure changes (34% vs 9%).
- Higher body-mass index and inadequate sponge/instrument counts were associated with retained foreign bodies.
- Multivariate analysis identified emergency surgery (RR 8.8), unplanned procedure changes (RR 4.1), and body-mass index (RR 1.1 per unit) as significant risk factors.
Conclusions:
- Emergency surgery, unplanned procedural changes, and higher body-mass index significantly increase the risk of retaining foreign bodies.
- Case-control analysis of malpractice claims is effective for identifying and quantifying risks of specific medical errors.