Reviewed By Dr. Lawrence Jones II
Recent articles have been published in the Philadelphia Inquirer (April 2024), touching on complications from medical surgeries over the last few years in the news. However, these are cases in which medical equipment is mistakenly left inside a person, and the person develops devastating effects afterward. Although rare, extreme cases happen within hospitals. Ruderman and Gantz (April 3, 2024) reported that there were “203 cases in which patients at 39 Philadelphia-area hospitals received treatment related to a surgical item accidentally left inside their bodies during a procedure, according to an analysis of Pennsylvania hospital billing records from 2017 through 2022.”
When I read this, I paused and thought, “How could this happen?” A few possible reasons, as Kumar and associates report:
1) Failure to count the swabs and surgical items in open surgeries is one of the risk factors.
2) Emergency surgeries can have sudden deviations in the surgery plan or improper swab count.
3) Higher body mass index (heavier weight individuals) is also believed to be a contributing factor due to increased technical difficulty, increased stress to the surgeon, and increased surgically exposed area.
Ruderman and Gantz stress that “while most patients are under anesthesia during surgery, they can still play a crucial role in their own safety. They can familiarize themselves with hospital safety measures to prevent objects from being left behind and discuss the protocols with their surgeon before the procedure. “When medical items get left inside patients, the suffering does not discriminate by age, race or zip code. The Inquirer’s analysis identified 203 affected patients at 39 hospitals in Philadelphia and its four surrounding Pennsylvania counties.”
Ruderman and Gantz cite that “65 of 203 cases occurred at Philadelphia institutions such as the Hospital of the University of Pennsylvania (HUP) and smaller suburban facilities, such as independent Doylestown Hospital in Bucks County and Main Line Health’s Paoli Hospital in Chester County.” Dr. Marcus Schabacker, president and CEO of ECRI a national nonprofit focusing on patient safety, notes that 75,000 to 100,000 people in the U.S. die each year from preventable medical errors, including surgical objects mistakenly left in a patient’s body. Dr. Schabacker is an anesthesiologist and intensive care specialist.
The purpose for the review is really for patients and family members to stay engaged with their hospital medical providers. Family members, loved ones and friends need a health advocate during their medical stays and procedures. There are some excellent hospitals and health care facilities around the country and world. People do have to remain alert, the doctor and the patient, because accidents happen. Hopefully more accidents can be caught before they develop into something life threatening. The Narrative Matters!
References:
Kumar GVS, Ramani S, Mahajan A, Jain N, Sequeira R, Thakur M. Imaging of retained surgical items: A pictorial review including new innovations. Indian J Radiol Imaging. 2017 Jul-Sep;27(3):354-361. doi: 10.4103/ijri.IJRI_31_17. PMID: 29089689; PMCID: PMC5644334
Ruderman,W. and Gantz,S. (April 3, 2024). Having surgery? Here’s what patients can ask surgeons to help prevent a particularly harmful error. What hospitals can do to prevent life-threatening surgical errors (inquirer.com)
Ruderman,W., Gantz,S., Purcell,D. (April 3, 2024). LEFT BEHIND
At Philadelphia-area hospitals, surgical teams mistakenly left objects inside patients’ bodies more than 200 times over six years. While rare, the error can cause catastrophic harm.
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