What is the appropriate course of action when a surgeon refuses a radiograph (x-ray) to confirm the presence of a retained surgical pack (gauze) despite the operating room (OR) nurse's concern, resulting in a patient returning with abdominal pain due to a retained pack 2 weeks post-operatively?

From the Research

The correct answer is A. Surgeon must be blamed for refusing x-ray. When a nurse reports a missing pack during surgery, the surgeon has a professional and ethical responsibility to take this concern seriously and follow proper protocol, which includes obtaining an x-ray before closure. By refusing to do so despite being alerted to a potential retained foreign object, the surgeon demonstrated negligence that directly led to patient harm, as supported by studies on postoperative complications and their impact on patient-centered outcomes 1, 2, 3, 4, 5. The surgeon's experience, regardless of how extensive, does not exempt them from following safety procedures designed to prevent such complications. While the entire team shares responsibility for patient safety, the surgeon, as the leader of the operating team, bears ultimate accountability for the decision to close without confirming all materials were removed, especially after being explicitly warned about a missing pack. This case represents a clear example of how overconfidence can compromise patient safety and lead to preventable complications such as pain, infection, and the need for additional surgery, highlighting the importance of adherence to protocol and teamwork in preventing postoperative complications 4. Key factors that contribute to the propagation of additional postoperative complications include the presence of comorbidities, higher ASA grade, higher BMI, emergency surgery, open surgery, palliative surgery, deeper cavity surgery, higher intraoperative blood loss, prolonged surgical duration, intraoperative complications, and contaminated surgical wounds 3, 4. Understanding these risk factors can guide surgeons to adopt appropriate strategic measures to reduce postoperative complications and improve the quality of surgical care, such as preoperative patient optimization, diligence during surgery, and implementation of infection control practices 4. Ultimately, the responsibility for ensuring patient safety and preventing complications lies with the entire surgical team, but the surgeon's decision-making and adherence to protocol are critical in preventing harm to the patient.