Assessing the diagnostic value of radiographs for retained surgical items: a cautionary analysis

To evaluate the sensitivity, specificity, and overall diagnostic performance of X-ray imaging in detecting retained surgical foreign bodies (RSFBs) during and after elective surgical procedures.

Over six years, a total of 145 cases of surgical missed item events (SMIEs) were reported; in 69 (47.58%) cases, a diagnostic image was indicated. Statistical results and significant cases are presented.

The mean age was 56.81 years, and 70.76% were females. General surgery accounted for the highest number of adverse events, with 28 cases (43.07%), while needles were the most frequently lost items, which is also reported in 28 cases (43.7%). The prevalence of the X-ray imaging to locate a foreign body was 46.5%, sensitivity 30%, specificity 100%, and accuracy 99.98%. Due to its low sensitivity, a negative X-ray cannot rule out the presence of an RSFB. A total of 14 (21.54%) complications were registered, and no deaths occurred.

X-rays are highly specific, when an item is detected, and it is truly present, but their low sensitivity means that a negative image cannot rule out a retained foreign body. Negative findings should not be considered definitive, particularly in high-risk cases.

The study shows that while X-rays offer high specificity (100%) and accuracy (99.98%), their sensitivity remains low at 30%. X-rays are effective at confirming the presence of foreign bodies, but less reliable in ruling out their absence. The key takeaway here is the need for supplemental imaging modalities in cases where high suspicion of RSFBs is raised by a negative X-ray.

NCT04293536.