University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
J Am Coll Surg. 2012 Oct;215(4):524-33. doi: 10.1016/j.jamcollsurg.2012.06.014. Epub 2012 Jul 6.
Despite rigorous manual counting protocols and the classification of retained surgical items (RSIs) as potential "never events," RSIs continue to occur in approximately 1 per 1,000 to 18,000 operations. This study's goals were to evaluate the incorporation of a radiofrequency detection system (RFDS) into existing laparotomy sponge- and Raytec-counting protocols for the detection of RSIs and define associated risk factors.
All patients undergoing surgery at the University of North Carolina Hospitals from September 2009 to August 2010 were enrolled consecutively. The performance of an RFDS-incorporated accounting protocol for detecting RSIs was prospectively evaluated. Several operative metrics were recorded to identify risk factors for miscounts.
A total of 2,285 patients were enrolled. One near miss was detected by the RFDS. Thirty-five miscounts occurred, for a rate of 1.53%. The ultimate locations of miscounted items were surgical site (n = 11), within operative suite (n = 10), surgical drapes (n = 2), and emergency protocol deviations (n = 12). Perioperative variables associated with miscounts were higher estimated volume of blood lost, longer operations, higher number of laparotomy sponges used, open surgical approach, "after hours" operations, change of surgical team during operation, weekend or holiday operations, unanticipated changes in operative plan during surgery, and emergency operations. Body mass index was not associated with miscounts. Surveys completed by participating surgical staff suggested high confidence in the RFDS for prevention of RSIs.
The incorporation of the RFDS assisted in the resolution of a near-miss event (1 of 2,285) not detected by manual counting protocols and assisted in the resolution of 35 surgical-sponge miscounts. No known RSIs occurred during the study period. Risk factors for miscounts were identified and can help identify at-risk surgical populations.
尽管采用了严格的手动计数规程，并将遗留手术器械（RSI）分类为潜在的“永不发生事件”，但在每 1000 至 18000 例手术中仍会发生约 1 例 RSI。本研究的目的是评估将射频检测系统（RFDS）纳入现有的剖腹手术海绵和 Raytec 计数规程中，以检测 RSI 并确定相关的危险因素。
连续纳入 2009 年 9 月至 2010 年 8 月期间在北卡罗来纳大学医院接受手术的所有患者。前瞻性评估了纳入 RFDS 的核算规程检测 RSI 的性能。记录了多个手术指标，以确定误计数的危险因素。
共纳入 2285 例患者。RFDS 检测到 1 例接近漏报。发生了 35 例误计数，发生率为 1.53%。误计数物品的最终位置为手术部位（n=11）、手术室内（n=10）、手术布单（n=2）和紧急方案偏差（n=12）。与误计数相关的围手术期变量包括估计出血量较高、手术时间较长、使用的剖腹手术海绵数量较多、开放手术方法、“非工作时间”手术、手术期间手术团队的变更、周末或节假日手术、手术期间手术计划的意外变化和急诊手术。体重指数与误计数无关。参与手术的医护人员完成的调查表明，他们对 RFDS 高度信任，认为其可预防 RSI。
RFDS 的纳入有助于解决手动计数规程未检测到的接近漏报事件（2285 例中的 1 例），并有助于解决 35 例手术海绵误计数。在研究期间未发生已知的 RSI。确定了误计数的危险因素，有助于确定高危手术人群。
