title: The retained surgical sponge.
abstract: OBJECTIVE
  A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges.
  
  
  METHODS
  Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period.
  
  
  RESULTS
  Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied.
  
  
  CONCLUSIONS
  Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures.
authors.affiliation: Department of Surgery, Department of Veterans Affairs Medical Centre, Manchester, NH 03104, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Kaiser
authors.forename: S
authors.initials: S
authors.lastname: Friedman
authors.forename: K P
authors.initials: KP
authors.lastname: Spurling
authors.forename: T
authors.initials: T
authors.lastname: Slowick
authors.forename: H A
authors.initials: HA
authors.lastname: Kaiser
mesh_terms: D000005:Abdomen; D003365:Costs and Cost Analysis; D005260:Female; D005547:Foreign Bodies / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D007351:Insurance, Liability / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008404:Massachusetts / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D015503:Surgical Sponges / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data