title: Managing the prevention of retained surgical instruments: what is the value of counting?
abstract: OBJECTIVE
  Preventing retained foreign bodies is critical for patient safety. However, the value of counting surgical instruments and the reliability of the information provided have never been quantified. This study examines the diagnostic characteristics of counting and its impact on surgical costs.
  
  
  METHODS
  We examined data from the Medical Event Reporting System-Total HealthSystem (MERS-TH), administrative hospital, and the New York State Cardiac Surgery Report databases (2000-2004). The cost per count discrepancy was examined by studying a cohort of patients undergoing coronary artery bypass graft (CABG) surgery. Linear and logistic multivariable regression models were used for statistical analysis.
  
  
  RESULTS
  Of 153,263 operations, there were 1062 count discrepancies. The rate of retained items was 1 of 7000 surgeries or 1 of 70 discrepancy cases. Final count discrepancies identified 77% and prevented 54% of retained items. The sensitivity of counting was 77.2%, specificity was 99.2%, but the positive predictive value was only 1.6%. Count discrepancies increased with surgery duration, late time procedures, and number of nursing teams. Bypass time, intravenous nitroglycerin injections, or myocardial infarction in the previous 24 hours were independent predictors of count discrepancies in CABG surgery. The incremental OR cost for CABG because of a count discrepancy was $932. Nationally, this would amount to an additional $24 million/yr in OR CABG cost.
  
  
  CONCLUSIONS
  This study, for the first time, quantifies the diagnostic accuracy of counting and defines the parameters against which alternative strategies of prevention should be measured, before being adopted in standard practice.
authors.affiliation: InCHOIR-International Center for Health Outcomes and Innovation Research, Department of Surgery, Columbia University, 600 W. 168th Street, New York, NY 10032, USA. ne30@columbia.edu
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
authors.forename: Alan
authors.initials: A
authors.lastname: Moskowitz
authors.forename: Annetine
authors.initials: A
authors.lastname: Gelijns
authors.forename: Alan
authors.initials: A
authors.lastname: Weinberg
authors.forename: James
authors.initials: J
authors.lastname: Curty
authors.forename: Barbara
authors.initials: B
authors.lastname: Rabin-Fastman
authors.forename: Harold
authors.initials: H
authors.lastname: Kaplan
authors.forename: Mary
authors.initials: M
authors.lastname: Cooper
authors.forename: Dennis
authors.initials: D
authors.lastname: Fowler
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Greco
mesh_terms: D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000295:instrumentation*; D005547:Foreign Bodies / Q000517:prevention & control*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D009873:Operating Rooms; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013525:Surgical Instruments