No sponge left behind

In a rare but distasteful complication in about 3,000 of the 40 million surgeries performed in the United States each year, somebody forgets something inside someone. The majority of forgotten items, about two-thirds, are surgical gauze sponges.

A new study holds the promise that technology will soon help doctors and nurses, with the wave of a wand, make sure they have taken everything out of a patient's surgical cavity that they brought in -- including the gauze pads that may not show up on a post-surgical X-ray.

In the study, published last week in the journal Archives of Surgery, eight patients undergoing abdominal or pelvic surgery at Stanford University School of Medicine agreed to have surgeons use gauze sponges tagged with radio-frequency identification chips during their procedures. After the operation was complete, and before the patient's wound was closed, one surgeon turned away while another placed a tagged sponge inside the cavity.

When the first surgeon then passed a hand-held, wand-like scanning device over each patient, he or she could correctly pinpoint the location of the tagged sponge left behind. Within three seconds, the sponges were found and removed.

The study shows that the solution to this particular medical mistake is likely to be technological, says Dr. Atul Gawande, surgeon at Boston's Brigham and Women's Hospital who has studied surgical mistakes. Operating room personnel are supposed to count every instrument and sponge three to four times before and after surgery, he notes.

"At first, you think, 'How stupid could nurses and doctors be? This is a problem of negligence,' " he says. "But if you've ever had to count 52 cards in a deck, you know that once in a while you get it wrong."

There's an especially high chance someone will get the count wrong -- or skip it altogether -- after a catastrophe such as a car accident, when seconds count in saving lives. In a landmark 2003 study in the New England Journal of Medicine, Gawande reviewed 54 malpractice cases involving retained foreign objects. He found that what puts patients at risk are emergency situations, midsurgery changes in the operating plan, and obesity.

"In an obese patient, with a standard opening, things can go farther away inside," he says.