Retained Surgical Items (RSIs) are a serious, recognized form of medical error where materials are unintentionally left inside a patient after surgery. These occurrences are considered “never events” in healthcare, meaning they are preventable. While statistically uncommon, the physical and emotional impact on a patient can be severe. Understanding the risks and how the healthcare system addresses this failure in patient safety is important.
What Are Retained Surgical Items
Retained Surgical Items (RSIs) are materials, instruments, or devices unintentionally left inside a patient’s body following an invasive procedure or surgery. They are broadly categorized into soft goods and hard goods. Soft goods, such as sponges, gauzes, and towels, are the most frequently reported type because they can easily become saturated with blood and blend into tissues.
Hard goods include small fragments, like broken needle tips and guide wires, or larger items such as clamps and forceps. Some items contain radio-opaque markers designed to make them detectable on X-ray films. However, detection is not absolute, and items without specialized markers remain difficult to locate.
Recognizing Symptoms
Symptoms of an RSI often develop days, weeks, or even years after the initial surgery. The most common complaint is chronic or unexplained pain that persists long after expected postoperative discomfort has resolved. This pain may be localized to the incision site or radiate, depending on whether the item is pressing on nerves or organs.
Signs of infection frequently appear, including persistent fever, chills, and abnormal discharge or swelling near the surgical wound. If the item is in the abdominal or pelvic cavity, patients may experience gastrointestinal issues. These range from nausea and vomiting to constipation, difficulty urinating, or signs of bowel obstruction. A patient might also notice a palpable mass or lump near the surgical site, as the body attempts to wall off the foreign object.
Medical Consequences
The presence of a foreign object triggers biological responses leading to severe medical pathology. The body attempts to isolate the material, resulting in chronic inflammation and the formation of an abscess around the item. This reaction can lead to dense scar tissue, known as adhesions, which abnormally bind internal organs together.
Retained items can also cause mechanical damage, especially if they are sharp or rigid. This damage may result in organ perforation, causing internal bleeding, or obstruction, particularly in the gastrointestinal tract. Chronic inflammation may cause the body to form a fistula, an abnormal channel connecting two organs or the organ to the skin. If the item harbors bacteria, a severe, widespread infection known as sepsis may develop, requiring immediate medical intervention.
Diagnosis and Removal
When an RSI is suspected due to persistent or unusual postoperative symptoms, specialized imaging techniques are used for confirmation. Plain X-rays are the first line of defense, effective for detecting radio-opaque items or soft goods containing a marker. However, items without markers or those obscured by tissue require more advanced modalities.
Computed Tomography (CT) scans are frequently utilized as the preferred method because they provide detailed cross-sectional images that distinguish the foreign body from surrounding tissue. Ultrasound and Magnetic Resonance Imaging (MRI) may also be used depending on the item’s suspected location and nature. Once the RSI is confirmed and located, a second operation is necessary for retrieval. This follow-up procedure carries risks but is essential to prevent long-term harm.
Patient Recourse and Prevention
The unintended retention of a surgical item is classified as a “never event” because it is a fully preventable error. Healthcare institutions are mandated to report these serious events to patient safety organizations, fostering transparency and accountability. Hospital protocols focus heavily on meticulous counting procedures for all instruments, sponges, and sharps before, during, and after surgery.
Despite these protocols, human error can occur, particularly during emergency surgeries or procedures involving unexpected changes. To bolster prevention, many facilities are implementing new technologies, such as radiofrequency identification (RFID) tagging. These systems embed tiny chips into surgical sponges, allowing staff to scan the patient before closure to electronically confirm all tagged items have been accounted for. Patients experiencing this error have the right to report the event to state medical boards and may pursue legal recourse to address the harm and financial burden associated with required follow-up care.