What is the most accurate method to decrease the risk of retained sponge during surgery?

Thorough Wound Inspection Before Closing Any Surgical Incision Is the Most Accurate Method to Decrease Risk of Retained Sponges

Thorough inspection of the surgical wound before closure is the most accurate method to decrease the risk of retained surgical sponges during surgery.

Understanding the Problem of Retained Surgical Items

• Retained surgical items (RSIs), particularly sponges, represent serious patient safety events with significant potential for patient harm, with an estimated incidence of 1 in 5,500 operations 1
• Surgical sponges account for the majority of retained foreign objects, with most commonly being retained in the abdomen/pelvis (50.2%) and vagina (23.9%) 2
• The median time between the original procedure and diagnosis of retained sponges can be as long as 2.2 years, leading to complications including adhesions (31%), abscesses (24%), and fistulas (20%) 3

Effectiveness of Different Prevention Methods

Thorough Wound Inspection

• Thorough inspection of the wound before closing any surgical incision is the most effective method to prevent retained surgical sponges, as it allows direct visualization of the operative field to identify any potentially retained items 4
• Visual detection of surgical sponges has been shown to be 100% accurate in certain procedures, demonstrating the importance of direct inspection 5

Sponge Counting Procedures

• Despite the use of radio-opaque sponges and thorough sponge counting, retained sponges still occur, with studies showing that in most cases of retained sponges, the count was falsely pronounced correct at the end of surgery 6, 3
• Limiting the use of sponges by liberal use of suction (Option A) does not address the fundamental issue of detection and may actually increase risk by reducing vigilance

Radiographic Detection

• Radiographs in patients undergoing multiple procedures (Option B) is not the most accurate method as it is reactive rather than preventive
• Routine radiographs in patients with BMI >40 (Option D) may be helpful in high-risk cases but is not the most accurate overall method compared to thorough inspection 2
• Studies show that despite the use of radiographic evaluation for incorrect sponge counts, retained surgical items still occur 5

Timing of Wound Closure

• Delaying wound closure until the count is completed (Option C) is an important procedural step but is less effective than thorough inspection of the wound before closure 4
• Count discrepancies can still occur even with proper counting procedures, making visual inspection crucial 6

Risk Factors for Retained Surgical Sponges

• Emergency operations increase the risk of retained surgical items 6
• Patient obesity is a significant risk factor for retained sponges 2, 6
• Multiple procedures, staff changes during surgery, and poor communication are contributing factors 3

Recommended Approach to Prevent Retained Sponges

1. Conduct methodical counts at critical points during surgery (before procedure, before closure of cavity within cavity, before wound closure begins, at skin closure) 4
2. Perform thorough visual inspection of the wound before closure 4
3. Implement standardized counting protocols with documentation 2
4. Consider adjunct technology like radiofrequency detection in high-risk cases 1
5. Maintain clear communication among surgical team members throughout the procedure 3

Thorough wound inspection before closing any surgical incision remains the most accurate method to decrease the risk of retained sponges as it provides direct visual confirmation that no foreign objects remain in the surgical field, which is more reliable than counting procedures or radiographic detection alone.