The Medical and Legal Impact of Retained Surgical Items (RSIs)

Imagine experiencing stomach pain, nausea, and fever. Worried, you head to the doctor, where you’re told you have appendicitis and need surgery to improve. You go through with the procedure, and as you start to heal, you realize the pain never actually went away. After a follow-up X-ray, your medical team finds a surgical sponge that was left inside your abdomen. Now, you face another operation and another round of recovery, all from a mistake that should’ve never happened.

How would you feel?

Retained surgical items (RSIs), also known as retained foreign bodies, or retained foreign objects, are medical tools, most commonly sponges, that are mistakenly left inside a patient’s body after a surgical procedure. Though rare, occurring in roughly 1 in 5,500 surgeries, they are classified as “never events” in healthcare, meaning they’re preventable, serious errors. When they do happen, the consequences can be life-altering for patients and costly for the medical industry.

The Legal and Human Costs of Retained Surgical Items

Despite efforts to reduce RSIs, these events can lead to severe health consequences for patients. Compensation in these cases can range from nearly $40,000 to over $2 million, depending on the severity.

One particularly egregious case involved a Kentucky patient who endured five years of chronic pain after bypass surgery, only to discover an 18-by-18-inch sponge had been left in her abdomen. The resulting lawsuit led to a multimillion-dollar verdict.

In another case, a California woman endured years of pain and nausea, repeatedly misdiagnosed with constipation or other gastrointestinal issues. Only later did doctors discover the true cause, a surgical sponge encased in scar tissue. By then, her condition had worsened to the point that she required partial intestine removal. Despite the severity of her case, state malpractice caps limited her compensation.

As with most medical negligence cases, proving fault isn’t straightforward. For example, in Texas, a jury ruled in favor of a surgeon even though a sponge was discovered in the patient’s abdomen months after surgery. The defense successfully argued that the surgeon had reasonably relied on staff for sponge counts, while the patient’s failure to refill her pain medication and her infrequent pain complaints undermined her claim.

Cases like this underscore the importance of thorough medical record reviews in establishing negligence.

Risk Factors for Retained Surgical Items

RSIs are more likely to occur in emergency surgeries, lengthy procedures, surgeries involving unexpected changes, and operations on the abdomen, pelvis, or thoracic cavity. Despite manual counting commonly used as a preventative measure, studies show that 80–100% of retained sponges that are found in patients come after counts were reported as correct.

Detection and Consequences of Retained Surgical Items

RSIs are typically identified soon after a procedure, often during routine follow-up visits through post-op X-rays, signs of abnormal inflammation, or the patient’s report of pain and discomfort. Some hospitals now conduct routine X-ray screenings before transferring patients to recovery, which has shown to reduce RSI cases and improve patient outcomes.

While some RSIs cause immediate symptoms, others remain undetected for months or even years. Persistent pain, recurrent infections, or a palpable mass can indicate a retained item. Over time, diagnosing an RSI becomes more challenging though, as symptoms often mimic other conditions. In these cases, CT or MR imaging is crucial for confirmation.

The consequences of RSIs can be severe, leading to bowel obstructions, intestinal damage, fistula formation, and gastrointestinal bleeding. In rare cases, RSIs have even led to patient fatalities. Regardless of when an RSI is discovered, removal is necessary, often requiring another surgery, further increasing medical costs.

Why RSI Incidents Still Happen

Operating rooms are fast-paced, high-pressure environments where procedural deviations can occur. Research links RSIs to procedural failures, hierarchical challenges, and lacking education. Despite strict protocols, human error remains a significant factor in RSI cases. Recognizing this, the Association of periOperative Registered Nurses introduced the NoThing Left Behind policy in 2015, recommending five separate visual and audible counts during procedures.

How a Legal Nurse Consultant Can Assist in RSI Cases

For medical malpractice attorneys handling RSI cases, partnering with a legal nurse consultant is invaluable. Our team meticulously reviews medical records, constructs detailed timelines, and identifies potential lapses in protocol. By assessing medical costs and future care needs, we help you build a strong body of evidence so you can secure fair compensation for your client.

RSIs are a preventable yet devastating medical error. If you’re handling a case involving a retained surgical item, Integrity Legal Nurse Consulting PDX can provide the expertise you need to connect medical data with legal strategy.

Schedule a free consultation to find the right legal nurse consultant for your case. We serve attorneys in Oregon, Washington, Idaho, Alaska, and beyond.

Photo courtesy of Prashant Mudgal, Radiopaedia.org, rID 27223.

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