http://customwire.ap.org/dynamic/stories/S/SURGICAL_TOOLS?SITE=NYWNE&SECTION=HOME
Jan 16, 4:11 AM EST
Surgery Tools Left in 1,500 People a Year
By JEFF DONN
Associated Press Writer
BOSTON (AP) -- A study on medical mistakes found operating room teams around
the country leave sponges, clamps and other tools inside about 1,500
patients every year, largely because of stress from emergencies or
complications discovered during surgery.
Both the researchers and several other experts agree the number of such
mistakes is small compared with the roughly 28 million operations a year in
the United States. However, they say there is room to improve.
"It shows the system works. It just doesn't work perfectly," said Verna
Gibbs, a surgeon at the University of California-San Francisco who has done
separate research on medical mistakes.
Dr. Sidney Wolfe, health research director of the public-interest lobby
group Public Citizen, was more critical. He said the real number of lost
instruments may be even higher, because hospitals are not required to report
such mistakes to public agencies.
He also pointed to the study's finding that surgical teams failed to count
equipment before and after the operation, in keeping with standard practice,
in one-third of cases where something was left behind. It tended to happen
during emergencies.
"It's not something that takes a lot of time," Wolfe said. "I just don't
think it's excusable."
The study, which was published Thursday in The New England Journal of
Medicine, was done by researchers at Brigham and Women's Hospital and
Harvard School of Public Health, both in Boston. It is the biggest and most
reliable study yet on such mistakes.
The researchers checked insurance records from about 800,000 operations in
Massachusetts for 16 years ending in 2001. They counted 61 forgotten pieces
of surgical equipment in 54 patients. From that, they calculated a national
estimate of 1,500 cases yearly. A total of $3 million was paid out in the
Massachusetts cases, mostly in settlements.
Most lost objects were sponges, but also included were metal clamps and
electrodes. In two cases, 11-inch retractors - metal strips used to hold
back tissue - were forgotten inside patients. In another operation, four
sponges were left inside someone.
The lost objects were usually lodged around the abdomen or hips but
sometimes in the chest, vagina or other cavities. They often caused tears,
obstructions or infections. One patient died of complications, but the
researchers withheld details for reasons of privacy.
Most patients needed additional surgery to remove the object, but sometimes
it came out by itself or in a doctor's office. In other cases, patients were
not even aware of the object, and it turned up in later surgery for other
problems.
The study found that emergency operations are nine times more likely to lead
to such mistakes, and operating-room complications requiring a change in
procedure are four times more likely. A rise of one point in body-mass
index, a measure of weight relative to height, raises the chances of such a
mistake by 10 percent. Researchers say big patients simply provide more room
and more fat in which to lose track of objects.
The length of the operation or the hour of day does not appear to make a
difference, suggesting that fatigue isn't at fault for the mistakes. "It
tends to be in unpredictable situations," said lead author Dr. Atul Gawande
of Brigham and Women's Hospital.
However, some other researchers say fatigue could promote such mistakes in a
way undetected by this study.
The Boston research team suggested more X-ray checks be done right after
those operations where such errors are most likely. Metal instruments and
radiologically tagged sponges show up in such checks.
Eventually, wands similar to supermarket bar-code readers might be developed
to detect missing equipment, researchers said.
However, some others said such mistakes are so rare - occurring about 50
times in 1 million operations - that figuring out how to prevent them could
be difficult.
"Something has to be done about this. It's just a very tough balance to
decide. Do we really want to add this hoop for every patient to jump
through?" said Dr. Kaveh Shojania, author of a 2001 federal study on medical
mistakes.
Lori Bartholomew, research director at the Physician Insurers Association of
America, said: "I find it's going to be difficult to make much more
improvement, because some of the risk factors are things that are hard to
control." The Rockville, Md., group represents medical malpractice insurers.
_________________________________________________________________
The new MSN 8: smart spam protection and 2 months FREE*
http://join.msn.com/?page=features/junkmail
_______________________________________________
http://www.mccmedia.com/mailman/listinfo/brin-l
- Re: Scouted: "It's a Junior Mint" becomes a re... Jon Gabriel
- Re: Scouted: "It's a Junior Mint" becomes... Julia Thompson
- Re: Scouted: "It's a Junior Mint" bec... Ronn! Blankenship
- Re: Scouted: "It's a Junior Mint"... Steve Sloan II
- Re: Scouted: "It's a Junior Mint"... Kevin Tarr
- Re: Scouted: "It's a Junior Mint" becomes... Medievalbk
- Re: Scouted: "It's a Junior Mint" bec... Richard Baker
- Re: Scouted: "It's a Junior Mint" becomes... Reggie Bautista
- Re: Scouted: "It's a Junior Mint" becomes... Jon Gabriel
- Re: Scouted: "It's a Junior Mint" becomes... Medievalbk
- Re: Scouted: "It's a Junior Mint" becomes... Medievalbk