title: The Role of Radio Frequency Detection System Embedded Surgical Sponges in Preventing Retained Surgical Sponges: A Prospective Evaluation in Patients Undergoing Emergency Surgery.
abstract: OBJECTIVE
  To prospectively evaluate the ability of radio frequency detection (RFD) system-embedded sponges to mitigate the incidence of retained surgical sponges (RSS) after emergency surgery.
  
  
  BACKGROUND
  Emergency surgery patients are at high risk for retained foreign bodies.
  
  
  METHODS
  All emergent trauma and nontrauma cavitary operations over a 5-year period (January 2010-December 2014) were prospectively enrolled. For damage-control procedures, only the definitive closure was included. RFD sponges were used exclusively throughout the study period. Before closure, the sponge and instrument count was followed by RFD scanning and x-ray evaluation for retained sponges. RSS and near-misses averted using the RFD system were analyzed.
  
  
  RESULTS
  In all, 2051 patients [median (range)], aged 41 (1-101) years, 72.2% male, 46.8% trauma patients, underwent 2148 operations (1824 laparotomy, 100 thoracotomy, 30 sternotomy, and 97 combined). RFD detected retained sponges in 11 (0.5%) patients (81.8%laparotomy, 18.2% sternotomy) before cavitary closure. All postclosure x-rays were negative. No retained sponges were missed by the RFD system. Body mass index was 29 (23-43), estimated blood loss 1.0 L (0-23), and operating room time 160 minutes (71-869). Procedures started after 18:00 to 06:00 hours in 45.5% of the patients. The sponge count was incorrect in 36.4%, not performed due to time constraints in 45.5%, and correct in 18.2%. The additional cost of using RFD-embedded disposables was $0.17 for a 4X18 laparotomy sponge and $0.46 for a 10 pack of 12ply, 4X8.
  
  
  CONCLUSIONS
  Emergent surgical procedures are high-risk for retained sponges, even when sponge counts are performed and found to be correct. Implementation of a RFD system was effective in preventing this complication and should be considered for emergent operations in an effort to improve patient safety.
authors.affiliation: Los Angeles County Medical Center and University of Southern California, Division of Trauma Surgery and Surgical Critical Care, Los Angeles, CA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Hande
authors.initials: H
authors.lastname: Aksoy
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.forename: Glenn
authors.initials: G
authors.lastname: Ault
authors.forename: Stephen
authors.initials: S
authors.lastname: Sener
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007813:Laparotomy / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D011846:Radio Waves; D056346:Sternotomy / Q000009:adverse effects / Q000295:instrumentation; D015503:Surgical Sponges; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation; D055815:Young Adult