Is There A Consent For That?

I don't think when a preoperative patient is given risks, benefits and alternatives by the surgeon that leaving a surgical instrument behind is the alternative the patient has in mind. Leaving the patient with "souveniers" to remember the occasion is not a memorable experience patients should be left with, yet it is a reality behind the confines of operating rooms across the country.

The actual statistics for this problem are unknown since a barrier of silence exist among staff members. Physicians never like to admit they are human, and nurses don't want to lose their jobs.

The current mechanism in place to prevent retained surgical objects in the operating room is in itself flawed due to one major problem: Human error. Counts of all instruments and sponges have to be taken preoperatively, perioperatively and just before closing; however, in some cases counts have been noted as correct when in fact there were retained surgical objects. Consistency in adherence to patient safety protocols seems to be deficient in these circumstances as surgical team members become too complacent with routine standards.

The cost to remove retained surgical objects can run thousands of dollars making the expense of human error a most costly as well as hazardous circumstance. The patients are ultimately the ones who suffer the consequences. There have even been some cases where surgical objects were not found until months or even years later.

Interruptions, distractions and chaos seem to play the biggest roles as the underlying causes of retained surgical objects. During my clinical career, most of the cases I have been aware of involved emergency cesarean sections with massive blood loss along with too many staff members in the operating room creating chaos.

Unfortunately, there is no room for error when is comes to surgical counts. The established standards of care should never be compromised with human oversight. As the challenges of manual counts continue with complicated cases, many facilities are searching for new technology to prevent such errors in the future.

Until then, the surgical team should always obtain an x-ray to reveal any foreign bodies at the end of complicated cases or when any question is raised regarding counts during the procedure. It is a simple, yet time-consuming solution. However, in these circumstances the entire surgical team must prioritize patient safety over impetuous completion. The surgical team needs to remember that the patients sign surgical consents based on the understanding they will receive compentent treatment, and somehow I don't think retained surgical objects ever fit into the category of competent treatment.