Surgical Instruments Left in Children Rarely Fatal, But Dangerous
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November 15, 2010
Surgical items, such as sponges and small instruments, left in the bodies of children who undergo surgery are quite uncommon and rarely fatal but decidedly dangerous and expensive mistakes, according to a Johns Hopkins Children’s Center study to be published in the November issue of JAMA-Archives of Surgery.
Such errors added eight days, on average, to a young patient’s hospital stay and nearly $36,000 in extra hospital charges, both stemming from complications and the need for follow-up surgery to retrieve the forgotten objects.
Analyzing more than 1.9 million records over 17 years detailing surgeries performed on children nationwide, the researchers identified 413 cases of items left behind, or 0.02 percent — an uncommon but costly and preventable error that can cause complications and require expensive repeat surgeries, the investigators say.
The retrospective study examined patient records after the fact and did not directly analyze factors such as operating room conditions and surgical routines that increased the chance of leaving items inside a patient. Yet the researchers noted that teenage patients undergoing surgeries for gynecological problems had the greatest risk—four times higher than other patients—based on how frequently they ended up being wheeled out of the OR with a surgical item left inside them. The finding suggests that some operations may be inherently riskier than others.
“It’s important to find out what mistakes we make as surgeons, but it is infinitely more important to know why we’re making them and how we can prevent them,” says principal investigator Fizan Abdullah, M.D., Ph.D., a pediatric surgeon at Hopkins Children’s.
The study did find a difference in death rates between patients with and without surgical items left in them after surgery, 1.7 percent compared with 0.7 percent, but the discrepancy was so small it could have been the result of pure chance, the investigators say.
Most instances of forgotten items involved gastrointestinal surgeries — 22 percent of the 413 episodes occurred during such procedures — followed by cardio-thoracic surgeries (16 percent) and orthopedic surgeries (13 percent).
The research was funded in part by the Robert Garrett Fund for Treatment of Children.
Other investigators in the study included Melissa Camp, M.D. M.P.H, David Chang, Ph.D. M.P.H. M.B.A., Yiyi Zhang, M.H.S., Kristin Chrouser, M.D. M.P.H., and Paul Colombani, M.D. M.B.A.
Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, with nearly 95,000 patient visits and some 9,000 admissions each year. Hopkins Children’s is consistently ranked among the top children's hospitals in the nation. Hopkins Children’s is Maryland's largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, visit www.hopkinschildrens.org.