Obasi Chidi, Etienne-Cummings Ralph, Lehmann Harold, Lewin Jonathan S, Asiyanbola B
Department of Surgery, School of Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA.
Technol Health Care. 2012 Sep 6. doi: 10.3233/THC-2012-0688.
Ahead of Print article withdrawn by publisher. Background: Postoperative retained foreign bodies [RFBs] can be a serious event, but they are rare. The x-ray is the current gold standard to detect RFBs. There has been scant research on the process of detection as opposed to the consequence of RFBs. Surgical sponges incorporating automatic data identity capture technology (radiofrequency tags, barcodes) have been proposed to detect RFBs. Because resources in healthcare are scarce, careful consideration needs to be given to developing the right technology in order to maximize the process of RFB elimination. There have been few studies that identify factors contributing to the process of RFB detection. Study design: Our goal was to determine the frequency with which x-rays were ordered to detect abdominal surgery post operative RFBs and the indications for ordering them. We reviewed the Johns Hopkins Hospital's Department of Radiology database to retrospectively study the demographic and radiologic data on patients who underwent exploratory surgery for RFBs following abdominal procedures performed between April 2004 and April 2008. Results: Of the 13,335 portable abdominal x-rays taken during the period, 203 (1.5%) were ordered to assess patients for the presence of an RFB. Of these, 57 (28%) were taken because no RFB count was made (e.g., for emergency procedures), 57 (28%) were taken per procedure or protocol, 51 (25%) were taken because of an incorrect instrument count, and 39 (19%) were taken because of an incorrect sponge count. Of the 203 x-rays, 192 (95%) were negative for RFBs, 11 (5%) were positive or had suspicious findings, and of these 3 (2%) revealed more than 1 RFB. The 11 patients with positive or suspicious findings underwent exploratory procedures immediately during the same operation; of these, 8 (72%) actually had an RFB and 3 (28%) had a negative result at exploration. Conclusion: Multiple pathways lead to the decision to obtain X-rays for RFBs, of which sponges/Incorrect sponge counts make up only one in five. Therefore, technology that focuses on sponges alone may not majorly impact clinical outcome because x-rays will still be required in the majority of cases of suspected high risk.
提前出版的文章被出版商撤回。背景：术后异物残留（RFBs）可能是严重事件，但很罕见。X线是目前检测RFBs的金标准。相对于RFBs的后果，关于检测过程的研究很少。有人提出采用包含自动数据识别技术（射频标签、条形码）的手术海绵来检测RFBs。由于医疗资源稀缺，需要谨慎考虑开发合适的技术，以最大限度地消除RFBs。很少有研究确定有助于RFB检测过程的因素。研究设计：我们的目标是确定为检测腹部手术后RFBs而开具X线检查的频率及其开具指征。我们回顾了约翰霍普金斯医院放射科数据库，以回顾性研究2004年4月至2008年4月期间接受腹部手术后因RFBs接受探查手术患者的人口统计学和放射学数据。结果：在此期间进行的13335次便携式腹部X线检查中，有203次（1.5%）是为评估患者是否存在RFBs而开具的。其中，57次（28%）是因为未进行RFB计数（如急诊手术）而进行的，57次（28%）是按照每次手术或方案进行的，51次（25%）是因为器械计数错误而进行的，39次（19%）是因为海绵计数错误而进行的。在203次X线检查中，192次（95%）RFBs呈阴性，11次（5%）呈阳性或有可疑发现，其中3次（2%）发现不止1个RFB。11例阳性或可疑发现的患者在同一手术期间立即接受了探查手术；其中，8例（72%）实际存在RFB，3例（28%）探查结果为阴性。结论：有多种途径导致决定为RFBs进行X线检查，其中海绵/海绵计数错误仅占五分之一。因此，仅专注于海绵的技术可能不会对临床结果产生重大影响，因为在大多数疑似高风险病例中仍需要X线检查。
