Kaiser C W, Friedman S, Spurling K P, Slowick T, Kaiser H A
Department of Surgery, Department of Veterans Affairs Medical Centre, Manchester, NH 03104, USA.
Ann Surg. 1996 Jul;224(1):79-84. doi: 10.1097/00000658-199607000-00012.
A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges.
Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period.
Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied.
Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures.
进行一项综述以调查手术中遗留手术海绵的患者的发生率及结局。
回顾了医疗专业互助保险公司（ProMutual，马萨诸塞州波士顿）档案中涉及手术中遗留手术海绵索赔的7年结案病例记录。
40例患者发生了手术海绵遗留，占所有异物遗留结案索赔的48%。在这些索赔中，76%记录了腹部手术后海绵计数错误但结果正确的情况。10%的索赔涉及阴道分娩和小型非体腔手术，这些手术未进行海绵计数。总赔偿金额为2,072,319美元，辩护费用为572,079美元。在三起案件中，尽管护理人员承认有责任且有证据表明外科医生完全符合护理标准，但法院仍判定外科医生有责任。尽管所研究患者的结局有显著相似性，但赔偿金额差异很大。
尽管手术中遗留手术海绵的报告很少见，但这种情况似乎比普遍认为的更常见。手术团队应确保对所有有海绵遗留风险的阴道手术和任何切口手术进行海绵计数。此外，外科医生不应不加质疑地接受正确的计数报告，而应养成在伤口闭合前对术后伤口/体腔进行简短但彻底的常规探查的习惯。大多数患者结局惊人地相似，这表明应进行标准化赔偿支付，而无需对抗性法律程序。
