Cost-effectiveness of routine radiographs after emergent open cavity operations
ABSTRACT Emergency surgery increases the risk of a retained surgical sponge (RSS) by 9-fold. In most cases, surgical counts are falsely reported as correct. We hypothesized that the institutional costs resulting from a RSS would make routine intraoperative radiography (IOR) more cost-effective than surgical counts in preventing RSS after emergent open cavity cases.
A cost-effectiveness analysis was performed to compare routine IOR with surgical counts after emergent open cavity operations. Parameter estimates were obtained from the literature, expert opinion via a standardized survey, and existing institutional data.
Routine IOR was the preferred strategy ($705 vs $1155 per patient) under the assumptions of the base case. The surgical count strategy was dominated by the institutional costs incurred after a RSS. Routine IOR was preferential as long as the sensitivity of surgical counts was less than 98% and the legal fees were more than $44,000 per case of RSS.
Routine IOR is 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 cost-effective strategy than surgical counts given the best available parameter estimates.
SourceAvailable from: Dário Birolini[Show abstract] [Hide abstract]
ABSTRACT: Background: Although there is an international mobilization to deal with unintentionally retained foreign bodies (RFB), since it is medical malpractice with potential legal implications, the cases are underreported, hindering the understanding and study of the problem. As a result, we face a recurrent and poorly understood event. This study explored the experience of brazilian surgeons on RFB and analyzed their characteristics and consequences. Study Design: In a three-month period, questionnaire was sent to surgeons members of nine brazilian societies, by electronic mail. Answering the questionnaire was volunteer. Answers were kept confidential and anonymous. The questions explored their experience with foreign bodies, FB types, clinical manifestations, diagnosis, risk and protection factors, and legal implications. Results: In 2872 eligible questionnaires, 43% of the doctors said they had already left FB and 73% had removed FB, in one or more occasions. Of these foreign bodies, 90% were textiles, 78% were discovered in the first year after the surgery and 14% remained asymptomatic. The occurrence of RFBs is more frequent in early professional career, in elective (54%) and routine (85%), but complex (57%) procedures. The main causes were emergency, lack of counting, inadequate work conditions, change of plans during the procedure and obese patients. Patients were alerted about the retention in 46% of the cases, and of these, 26% sued the doctors or the institution. Conclusion: The majority of unintentionally retained foreign bodies occurred at the beginning of the professional career, during routine surgical procedures. In general, foreign bodies caused symptoms and were diagnosed in the first year of the post-operative period. Textiles predominated. Inadequate work conditions were listed as RFB risk factors, as well as emergency surgery, for example. Less than half of the patients were aware of the adverse event and 26% sued the surgeons or the institutions involved in the procedure.12/2013, Degree: PHD, Supervisor: Samir Rasslan
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ABSTRACT: Despite near-universal implementation of protocols for surgical sponges, instruments and needles, incidents of retained surgical foreign bodies (RSFB) continue to be a significant patient safety challenge. We report a case of a 29-year-old woman who presented with small intestinal obstruction caused by complete intraluminal migration of a retained surgical sponge into the intestine 9 months after cesarean section. The diagnosis was confirmed by plain abdominal radiograph. The patient underwent exploratory laparotomy, sponge removal and became completely asymptomatic. Although safety standards for hospital employees have been developed during the past decades, no detection system to date has been evaluated as a replacement for traditional manual counting protocols and procedures. The best approach is the prevention of this condition, which can be achieved by implementation of standardized institutional regulations and strict adherence to them. Perhaps, with increasing use of the new technologies as adjunct to the counting, the incidence of RSFB will fall dramatically.05/2013; 2013(5). DOI:10.1093/jscr/rjt032
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ABSTRACT: Gossypibomas are foreign objects, usually surgical sponges or towels, accidentally retained in the human body during an operation. They are associated with significant postsurgical complications, morbidity and mortality. Postsurgical radiographs are considered the standard of care for a retained foreign body, but their detection sensitivity typically ranges between 60% and 80%. To address this we have microfabricated x-ray visible microtags that can be attached to foreign bodies and allow them to be easily recognized by a trained radiologist or a computer aided detection (CAD) algorithm. Key element of the microtag design is the use of three radiopaque beads placed in a precise, triangular configuration. We demonstrated that those microtags are visible in standard radiographs over different backgrounds (soft tissue, bone) and at different spatial orientations. We envision that these microtags attached to surgical sponges and towels will greatly increase the detection sensitivity and specificity of gossypibomas at an infinitesimal cost and will be used in the operating room to provide point of care information to the surgeons.Proceedings of SPIE - The International Society for Optical Engineering 02/2012; DOI:10.1117/12.910757 · 0.20 Impact Factor