Study asks why surgical tools were left in 1,500 patients

Report says emergencies, complications and patient obesity -- not negligence -- lead to objects being left inside patients.

By Andis Robeznieks, AMNews staff. Feb. 3, 2003.

A Jan. 16 New England Journal of Medicine report on foreign bodies left inside patients was cited plenty of times in recent news reports, but the author of the study thinks it may be cited even more in future court cases.

According to general surgeon Atul A. Gawande, MD, MPH, of Boston's Brigham and Women's Hospital, there has never been much hospitals and doctors could do legally to defend themselves if a sponge or surgical instrument was left in a patient because courts generally view these cases as res ipsa loquitur, which Dr. Gawande defines as "negligence, pure and simple."

"What we found by analyzing in a case-controlled method is there is no evidence of negligence," he said. "Instead, we found conditions in which surgical teams were stressed led to a greater risk for error. ... It runs exactly counter to the findings that these were the result of carelessness."

For example, in emergency surgeries, Dr. Gawande and his colleagues found that the risk for leaving a foreign body in a patient increased 900%. They also found that, when unexpected changes occur during a planned surgery, the risk increases 400%, and each 10-point increase in a patient's body-mass index translates into a 100% increase in risk.

"Our study really showed it isn't negligence, and a punishment approach is not likely to work [to prevent future cases]," Dr. Gawande said. "What we found were the same constellation of events and conditions that led to these errors."