Weprin Samuel, Crocerossa Fabio, Meyer Dielle, Maddra Kaitlyn, Valancy David, Osardu Reginald, Kang Hae Sung, Moore Robert H, Carbonara Umberto, J Kim Fernando, Autorino Riccardo
Division of Urology, Department of Surgery, VCU Health, Richmond, VA, 23298-0118, USA.
Division of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Patient Saf Surg. 2021 Jul 12;15(1):24. doi: 10.1186/s13037-021-00297-3.
A retained surgical item (RSI) is defined as a never-event and can have drastic consequences on patient, provider, and hospital. However, despite increased efforts, RSI events remain the number one sentinel event each year. Hard foreign bodies (e.g. surgical sharps) have experienced a relative increase in total RSI events over the past decade. Despite this, there is a lack of literature directed towards this category of RSI event. Here we provide a systematic review that focuses on hard RSIs and their unique challenges, impact, and strategies for prevention and management.
Multiple systematic reviews on hard RSI events were performed and reported using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. Database searches were limited to the last 10 years and included surgical "sharps," a term encompassing needles, blades, instruments, wires, and fragments. Separate systematic review was performed for each subset of "sharps". Reviewers applied reciprocal synthesis and refutational synthesis to summarize the evidence and create a qualitative overview.
Increased vigilance and improved counting are not enough to eliminate hard RSI events. The accurate reporting of all RSI events and near miss events is a critical step in determining ways to prevent RSI events. The implementation of new technologies, such as barcode or RFID labelling, has been shown to improve patient safety, patient outcomes, and to reduce costs associated with retained soft items, while magnetic retrieval devices, sharp detectors and computer-assisted detection systems appear to be promising tools for increasing the success of metallic RSI recovery.
The entire healthcare system is negatively impacted by a RSI event. A proactive multimodal approach that focuses on improving team communication and institutional support system, standardizing reports and implementing new technologies is the most effective way to improve the management and prevention of RSI events.
手术遗留物品（RSI）被定义为一种可避免的严重不良事件，会对患者、医护人员和医院造成严重后果。然而，尽管各方做出了更多努力，但RSI事件仍是每年排名第一的警示事件。在过去十年中，坚硬异物（如手术锐器）导致的RSI事件总数相对有所增加。尽管如此，针对这类RSI事件的文献却很匮乏。在此，我们进行了一项系统综述，重点关注坚硬异物导致的RSI事件及其独特的挑战、影响以及预防和管理策略。
按照PRISMA（系统综述和荟萃分析的首选报告项目）和AMSTAR（评估系统综述的方法学质量）指南，对坚硬异物导致的RSI事件进行了多项系统综述并予以报告。数据库检索限于过去10年，纳入了手术“锐器”，该术语涵盖针头、刀片、器械、金属丝和碎片。对“锐器”的每个子集分别进行了系统综述。评审人员运用相互综合和反驳综合的方法来总结证据并进行定性概述。
提高警惕和改进计数不足以消除坚硬异物导致的RSI事件。准确报告所有RSI事件和未遂事件是确定预防RSI事件方法的关键一步。已证明实施新技术，如条形码或射频识别标签，可提高患者安全性、改善患者预后并降低与遗留软性物品相关的成本，而磁性检索设备、锐器探测器和计算机辅助检测系统似乎是提高金属性RSI找回成功率的有前景的工具。
RSI事件会对整个医疗系统产生负面影响。一种积极主动的多模式方法，即专注于改善团队沟通和机构支持系统、规范报告并实施新技术，是改善RSI事件管理和预防的最有效方法。
