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Updated: May 8, 2026
The Polyvinyl Alcohol Sponge Model Implantation
Published on: April 18, 2012
WITHDRAWN: Sponges and incorrect sponge count: Minor contributions to the process of detecting retained foreign
Chidi Obasi1, Ralph Etienne-Cummings, Harold Lehmann
1Department of Surgery, School of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA.
Abstract:
Ahead of Print article withdrawn by publisher. Background: Postoperative retained foreign bodies [RFBs] can be a serious event, but they are rare. The x-ray is the current gold standard to detect RFBs. There has been scant research on the process of detection as opposed to the consequence of RFBs. Surgical sponges incorporating automatic data identity capture technology (radiofrequency tags, barcodes) have been proposed to detect RFBs. Because resources in healthcare are scarce, careful consideration needs to be given to developing the right technology in order to maximize the process of RFB elimination. There have been few studies that identify factors contributing to the process of RFB detection. Study design: Our goal was to determine the frequency with which x-rays were ordered to detect abdominal surgery post operative RFBs and the indications for ordering them. We reviewed the Johns Hopkins Hospital's Department of Radiology database to retrospectively study the demographic and radiologic data on patients who underwent exploratory surgery for RFBs following abdominal procedures performed between April 2004 and April 2008. Results: Of the 13,335 portable abdominal x-rays taken during the period, 203 (1.5%) were ordered to assess patients for the presence of an RFB. Of these, 57 (28%) were taken because no RFB count was made (e.g., for emergency procedures), 57 (28%) were taken per procedure or protocol, 51 (25%) were taken because of an incorrect instrument count, and 39 (19%) were taken because of an incorrect sponge count. Of the 203 x-rays, 192 (95%) were negative for RFBs, 11 (5%) were positive or had suspicious findings, and of these 3 (2%) revealed more than 1 RFB. The 11 patients with positive or suspicious findings underwent exploratory procedures immediately during the same operation; of these, 8 (72%) actually had an RFB and 3 (28%) had a negative result at exploration. Conclusion: Multiple pathways lead to the decision to obtain X-rays for RFBs, of which sponges/Incorrect sponge counts make up only one in five. Therefore, technology that focuses on sponges alone may not majorly impact clinical outcome because x-rays will still be required in the majority of cases of suspected high risk.
Insights
Postoperative retained foreign bodies (RFBs) are rare, and X-rays are often used for detection. Focusing only on sponge counts may not significantly reduce the need for X-rays, as other factors frequently trigger their use.
Area of Science:
- Medical Imaging
- Surgical Safety
- Radiology
Background:
- Postoperative retained foreign bodies (RFBs) are infrequent but serious complications.
- Current detection relies heavily on X-rays, with limited research on the detection process itself.
- Technological solutions like radiofrequency tags in surgical sponges have been proposed to mitigate RFBs.
Purpose of the Study:
- To determine the frequency of X-ray utilization for detecting abdominal surgery postoperative RFBs.
- To identify the primary indications for ordering these X-rays.
- To evaluate the effectiveness of X-ray detection in identifying actual RFBs.
Main Methods:
- Retrospective review of the Johns Hopkins Hospital's Department of Radiology database.
- Analysis of demographic and radiologic data for patients undergoing abdominal procedures between April 2004 and April 2008.
- Categorization of indications for ordering portable abdominal X-rays to detect RFBs.
Main Results:
- 1.5% of 13,335 abdominal X-rays were ordered for suspected RFBs.
- Indications included: no count (28%), protocol (28%), incorrect instrument count (25%), and incorrect sponge count (19%).
- 95% of X-rays were negative; of those with positive/suspicious findings, 72% confirmed RFBs upon exploration.
Conclusions:
- Multiple factors contribute to ordering X-rays for suspected postoperative retained foreign bodies.
- Sponge counts alone account for a minority of X-ray indications.
- Technologies solely targeting sponges may not substantially decrease the overall need for radiographic assessment in high-risk scenarios.
