A LARGE, PERSISTENT PROBLEM

Unintentionally retained surgical sponges are the most common surgical adverse event and lead to significant patient morbidity and cost ramifications1,2,3.

THE MOST COMMON SURGICAL ADVERSE EVENT

1 in 1,000 to
8,000 Surgeries

Estimated to occur 1 in every 1,000 to 1,500 abdominal operations and 1 in 8,000 general operations4.

4,000 Per Year
11 Every Day

With approximately 32 million procedures using surgical sponges in the U.S. annually, there are an estimated 4,000 retained per year, 11 every day.

Joint Commission’s Top
Sentinel Event

The Joint Commission consistently lists retained sponges as its leading Sentinel Event4.

SIGNIFICANT PATIENT
MORBITITY

  • Patient impact varies by incident and typically includes serious patient morbidity
  • Pain, infection, visceral perforation, small bowel fistula, additional surgery for removal and repair, patient mortality

CONSIDERABLE COST
RAMIFICATIONS

  • Legal awards, non-reimbursable corrective healthcare services alone average over $550,000 per incident
  • $2.2Bn of annual costs in the U.S. from these items alone, $68.81 per procedure
  • Additional costs include the negative impact on quality-of-care metrics, loss of time, negative impact on reputation

References

  1. Mehtsun, et al. Surgical never events in the United States, J Surg 2012;10.005
  2. Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am College of Surgeons, 2008;248:80-87.
  3. Sloane, Todd. The high cost of inaction: How retained surgical sponges quietly drain hospital finances and not-so-quietly harm organizational reputations. Becker’s Infection Control & Clinical Quality. Aug. 2013. Web. Sept. 2015.
  4. Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am College of Surgeons, 2008;248:80-87
  5. The Joint Commission, Summary Data of Sentinel Events Reviewed by the Joint Commission, Most Commonly Reviewed Sentinel Event Types, Feb. 2019
  6. Lauwers PR, Hee RHV. Intraperitoneal gossypiboma: The need to count sponges. World Journal of Surgery. 2000;24(5):521-527
  7. Actual Tally scanning results may vary and depend on multiple factors, including but not limited to the distance between the Tally scanner and Tally sponges, the condition of the Tally sponges and the number of Tally sponges presented to the scanner.