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Counts are good, but not enough, study finds
Counts are an essential tool for reducing the number of retained items in surgery, but they should be augmented with other strategies, according to one recent study.1
Counting surgical items, such as sponges and towels before and after their use to check for discrepancies, is the most widely used method for preventing retained items, but it is not perfect. People can still make errors in counting, particularly when there are distractions, interruptions, a need to hurry, or other pressures in the OR. To study the effectiveness of counting, as well as any effect on cost, researchers at Columbia University in New York City looked at all coronary artery bypass grafting (CABG) procedures conducted between 2000 and 2004. The total cost for CABG was obtained from the hospital financial database, and the additional cost related to count discrepancies, including the extra OR time and the additional cost of imaging, was calculated.
The researchers found that 1,062 count discrepancies were reported in 153,263 surgical procedures (0.69%) performed between 2000 and 2004. The rate of retained items was one in 7,000 surgeries or one in 70 discrepancy cases. Final count discrepancies identified 77% and prevented 54% of retained items with a sensitivity of 77.2% and a specificity of 99.2%; however, the positive predictive value was only 1.6%. Count discrepancies increased with surgery duration, late time procedures, and the number of nursing teams. The incremental OR cost for CABG because of a count discrepancy was $932.
The Columbia University researchers concluded that counting plays an essential role in preventing retained foreign bodies. The study was the first to quantify the diagnostic accuracy of counting. The authors determined that counts are effective but not sufficient on their own to prevent retained items; therefore, other strategies should also be used, such as mandatory X-rays during long or emergency procedures.
1. Egorova NN, Moskowitz A, Gelijns A, et al. Managing the prevention of retained surgical instruments: What is the value of counting? Ann Surg 2008; 247:13-18.