OutcomeCost-effectiveness of routine radiographs after emergent open cavity operations
Section snippets
The model
This study was conducted using a decision-analysis simulation design. Decision analysis is a quantitative technique for synthesizing data form numerous sources to evaluate diagnostic or therapeutic alternatives. All decision analyses involve the following steps: (1) the competing strategies and outcomes associated with each strategy are specified in a decision model; (2) the probabilities for each of these outcomes are estimated from the most appropriate available data and assigned to each
Results
Baseline analysis was performed using the base case assumptions described, and it incorporated the probabilities and costs of the reference case listed in Table I. According to the underlying assumptions of the model, the expected value (effectiveness) of IOR is 1.000, meaning that the model-derived incidence of RSS after the IOR strategy is less than 1 in 1000. Because sponge counts have false-negative results, the expected value for sponge counting is 0.999, or 1 RSS for every 1000 patients.
Discussion
Retained surgical instrument and sponges are among the most dreaded of surgical complications. The concern is particularly high after emergent cases when the hurried nature of pre- and intraoperative procedures can lead to medical errors. Although surgical counts are an accurate way to prevent RSS when they can be performed correctly (as for most elective cases), most cases of RSS occur after the count has been reported as correct. The most common reasons for falsely correct counts often apply
Conclusion
Currently, there is a tremendous amount of variability in the way that institutions address the issue of RSS and a paucity of evidence to support (or refute) an aggressive strategy of mandatory IOR in all open-cavity cases. The current study demonstrates routine IOR to be a simple, cost-effective option to reduce the occurrence of this preventable medical error. Institutional costs and legal fees associated with RSS dominate the cost of the surgical count strategy, making routine IOR a more
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Cited by (28)
Lower gastrointestinal bleeding due to colonic fistula caused by a gossypiboma: Case report and literature review
2020, International Journal of Surgery Case ReportsCitation Excerpt :It would help to prepare operative teams to approach more effectively such unplanned events [5,6]. One of the most important strategies consists on enhancing careful and thorough swabs and material counting, and in cases of discrepancy, a thorough cavitary exploration and/or radiographic imaging of the surgical field must be performed [1,2,9,14,15]. Besides, there are some studies that encourage us to classify the patients into high or low risk.
Identifying lost surgical needles with visible and near infrared fluorescent light emitting microscale coating
2018, Surgery (United States)The Hidden Costs of Reconciling Surgical Sponge Counts
2015, AORN JournalMiscount incidents: A novel approach to exploring risk factors for unintentionally retained surgical items
2013, Joint Commission Journal on Quality and Patient SafetyDesigning a Safer Process to Prevent Retained Surgical Sponges: A Healthcare Failure Mode and Effect Analysis
2011, AORN JournalCitation Excerpt :It may take up to 30 minutes to receive an oral report of an intraoperative radiograph. In addition, the cost of an intraoperative film to rule out retained surgical sponges has been calculated to be $705.10 Because of the limitations of the surgical count, and the lack of sensitivity of intraoperative radiographs, we recommend consideration of newer technologies for prevention of retained sponges (ie, bar coding, radio-frequency technology, RFID).
Sensitivity of detection of radiofrequency surgical sponges: A prospective, cross-over study
2011, American Journal of SurgeryCitation Excerpt :Using radiography to rule out the presence of a retained sponge in the abdomen of a morbidly obese patient often requires 2 overlapping films, potential contamination of the surgical drapes, and extra time. The cost of an intraoperative film to rule out retained surgical sponge has been calculated to be $705.16 A cost comparison with RF technology would likely provide a business case for adoption of RF technology.
Presented at the 3rd Annual Academic Surgical Congress, Huntington Beach, California, February 2008.
Supported in part by an Agency for Healthcare Research and Quality grant (T32 HS 013833 to L.A.D.).