William Walter MD, Presenter: Nothing to Disclose

Seymour Sprayregen MD, Abstract Co-Author: Nothing to Disclose

E. Stephen Amis MD, Abstract Co-Author: Nothing to Disclose

Linda Broyde Haramati MD, MS, Abstract Co-Author: Investor, OrthoSpace Ltd Investor, Kryon Systems Ltd Spouse, Board Member, Bio Protect Ltd Spouse, Board Member, OrthoSpace Ltd Spouse, Board Member, Kryon Systems Ltd

To determine the effectiveness of intraoperative (OR) radiography (x-ray) for evaluating surgical item miscounts and evaluate adherence to our institutional protocol to image the miscounted item.

We retrospectively reviewed 183 sequential OR x-rays in 180 patients (97 male, mean age 52 yrs, mean BMI 29) for surgical item miscounts 1/1/2011- 4/1/2013. X-rays were reviewed in consensus by 3 board-certified radiologists including follow-ups in 78% (142/183). Adherence to our institutional policy of x-raying the miscounted item was tracked.

OR miscounts requiring x-ray occurred in 0.9% (183/20,820) of surgeries. The most commonly miscounted items were needles (118) and sponges (17). Only 9% (17/183) were resolved; 8 items were outside the patient (4 needles, 3 sponges, 1 clamp). 5% (9/183) were ultimately resolved by x-ray, 5 immediately (2 needles, 3 sponges), 2 incidentally on follow-up (2 needles) and 2 during this study (1 needle, 1 microclip) for a false negative rate of 2% (4/183, all very small items). Miscounts were numerically most common with open heart surgery 45/1382 (3%), but occurred in higher proportions of esophagectomies 4/12 (33%), liver transplant 12/66 (18%) and Whipple 7/44 (16%). Item miscount x-ray protocol adherence was 91% (167/183). Items were detected and removed at the time of surgery in 3% (5/183) of cases. Delayed detection occurred in 2% (4/183) of cases and the items were not removed.

OR x-rays can effectively identify retained items, although small needles were difficult to detect. Despite a high level of adherence to imagining the miscounted item, positive OR x-rays are rare and miscounted items may be occult due to small size. Surgical needles were not routinely removed when found post-operatively.

Miscounted surgical needles are not routinely removed when found post-operatively, suggesting that x-rays for miscounted small needles may be unnecessary.

Walter, W, Sprayregen, S, Amis, E, Haramati, L, Lost and Found: Retrospective Analysis of the Use of Intraoperative Radiography for Evaluation of Incorrect Surgical Item Counts.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003368.html