title: Retained surgical items: a problem yet to be solved.
abstract: BACKGROUND
  Retained surgical items (RSI) continue to occur. Large RSI studies are few due to low RSI frequency in single institutions and the medicolegal implications. Consequently, RSI risks are not fully defined, with discrepancies persisting among published studies. The goals of this study were to better define risk factors for RSI, to clarify previously discrepant risk factors, and to evaluate other potential contributors to RSI occurrence, such as trainee presence during an operation.
  
  
  METHODS
  Multicenter case-match study of RSI risk factors was conducted between January 2003 and December 2009. Cases complicated by RSI were identified at participating centers using clinical quality improvement and adverse event reporting data. Case match controls (non-RSI) were selected from same or similar-type cases performed at each respective institution. Retained surgical item risk factors were evaluated by univariate and multivariate conditional logistic regression.
  
  
  RESULTS
  Fifty-nine RSIs and 118 matched controls were analyzed (RSI incidence 1 in 6,975 or 59 in 411,526). Retained surgical items occurred despite use of confirmatory x-rays (13 of 27 instances) and/or radiofrequency tagging (2 of 32 instances). Among previously discrepant results, we confirmed that body mass index, unexpected intraoperative events, and procedure duration were associated with increased RSI risk. The occurrence of any safety variance, and specifically an incorrect count at any time during the procedure, was associated with elevated RSI risk. Trainee presence was associated with 70% lower RSI risk compared with trainee absence.
  
  
  CONCLUSIONS
  Longer duration of surgery, safety variances, and incorrect counts during the procedure result in elevated RSI risk. The possible positive influence of trainee presence on RSI risk deserves additional study. Our findings highlight the need for zero tolerance for safety omissions, continued study and development of novel approaches to RSI reduction, and establishing anonymous RSI reporting systems to better track both the incidence and risks associated with this problem, which has yet to be solved.
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA. stanislaw.stawicki@osumc.edu
authors.forename: Stanislaw P A
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Susan D
authors.initials: SD
authors.lastname: Moffatt-Bruce
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Ahmed
authors.forename: Harry L
authors.initials: HL
authors.lastname: Anderson
authors.forename: Tara M
authors.initials: TM
authors.lastname: Balija
authors.forename: Irina
authors.initials: I
authors.lastname: Bernescu
authors.forename: Liza
authors.initials: L
authors.lastname: Chan
authors.forename: Laurie
authors.initials: L
authors.lastname: Chowayou
authors.forename: James
authors.initials: J
authors.lastname: Cipolla
authors.forename: Susette M
authors.initials: SM
authors.lastname: Coyle
authors.forename: Vicente H
authors.initials: VH
authors.lastname: Gracias
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marchigiani
authors.forename: Niels D
authors.initials: ND
authors.lastname: Martin
authors.forename: Jigar
authors.initials: J
authors.lastname: Patel
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Eileen
authors.initials: E
authors.lastname: Vagedes
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D005547:Foreign Bodies / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D013525:Surgical Instruments