There is evidence that these reported incidences in the literature may even represent an underestimation secondary to underreporting.3,6–8 For example, the Mayo Clinic (Rochester, MN), a high-volume tertiary surgical referral institution that performs routine postprocedure radiography, reported a true rate of 1 in 5500 operations.9 It is disconcerting that this adverse event continues to occur at a measurable

rate despite widespread adoption of stringent protocols regarding the proper tracking and counting of sponges, Inhibitors,research,lifescience,medical needles, and instruments. In fact, a recent retrospective, case-control study suggested that greater than 1500 instances of retained foreign bodies occur annually in the United States.3 Although the complications associated with these events frequently arise acutely in the early postoperative period, discovery of the foreign body can in some instances be delayed for several months or even years before detection occurs secondary to a late complication.7 A recent retrospective case series reported that the time from causative operation Inhibitors,research,lifescience,medical to identification of Inhibitors,research,lifescience,medical the retained foreign body ranged from 3 days to 40 years.10 The most common symptoms associated with retained foreign bodies in the abdomen are pain and intestinal obstruction.5,10

In the acute setting, identification often occurs as a result of pain symptoms, bowel obstruction, ileus, or infectious complications.4,11 More delayed presentation can be prompted by the development of fistulae or a mass mimicking a tumor.4,12 In addition to the above-mentioned medical complications, retained foreign bodies result in considerable cost burden on the health care system. With respect to medical costs, the average Medicare payment for an admission related to a retained Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical foreign body has been reported to exceed $60,000. The Affordable Care Act specifically states that surgeries related to foreign bodies are not reimbursable. Furthermore, institutional costs are often surpassed by the medicolegal costs associated with resulting litigation, which have

been estimated to average $150,000 or more per case.13 much A recent review of closed malpractice claims found that 40 instances of retained foreign bodies generated a total of $2,072,319 in indemnity payments in addition to the $579,079 spent on check details defense costs. Mean and median payments for abdominal cases were $32,500 and $68,857, respectively.14 The occurrence of medical errors such as these often invites unfavorable media attention3 that can impart a significant embarrassment for both institution and surgeon. Several independent risk factors associated with retained surgical foreign bodies have been identified in the literature. Specifically, the risk appears to be greater in surgeries involving an unexpected change intraoperatively, operations involving more than one surgical team, and prolonged or emergent surgeries.