Retained foreign bodies after major operations: Trends, risk factors, and associated outcomes

Retained foreign bodies are rare complications of surgical practice that are associated with adverse events and increased health care costs. While previous work has reported on the incidence of retained foreign bodies, updated national data evaluating contemporary trends as well as risk factors and associated outcomes remain limited.

The 2018-2022 National Inpatient Sample was used to identify all hospitalizations entailing major cardiac, gastrointestinal, genitourinary, neurosurgical, orthopedic, thoracic, and vascular operations. Patients were categorized based on the presence of a retained foreign body. Multivariable regression models were developed to evaluate the association of retained foreign bodies with risk factors and outcomes of interest.

Of an estimated 26,333,269 surgical hospitalizations, 4,570 (0.017%) carried a concomitant diagnosis for a retained foreign body. The proportion of cases with a retained foreign body decreased from 1/5,400 to 1/6,000 cases from 2018 to 2022 (P <.001). Relative to cardiac operations, gastrointestinal (adjusted odds ratio, 2.26; 95% confidence interval, 1.63-3.13), thoracic (adjusted odds ratio; 3.22, 95% confidence interval, 2.05-5.10), vascular (adjusted odds ratio, 2.78; 95% confidence interval, 1.89-4.10), and multicavity (adjusted odds ratio, 2.10; 95% confidence interval, 1.50-2.93) operations were associated with greater odds of retained foreign body occurrence. Moreover, treatment at hospitals with small-bed size was linked to reduced likelihood of retained foreign body event (adjusted odds ratio, 0.79; 95% confidence interval, 0.65-0.95), whereas care at hospitals in the Western United States was associated with increased odds (adjusted odds ratio, 1.29; 95% confidence interval, 1.05-1.59). Retained foreign body occurrence was also associated with a greater risk of complications, prolonged hospital stay, and increased hospitalization costs.

Despite a declining incidence of retained foreign bodies, further efforts focused on standardized safety protocols and technological solutions are needed to achieve zero-incidence prevention.