A New Search Algorithm for Reducing the Incidence of Missing Cottonoids in the Operating Theater

Abstract

Study DesignRetrospective study.PurposeMissing cottonoids during and after spinal surgery is a persistent problem and account for the most commonly retained surgical instruments (RSIs) noticed during a final cottonoid count. The aim of this study was to enumerate risk factors and describe the sequence to look out for misplaced cottonoids during spinal surgery and provide an algorithm for resolving the problem.Overview of LiteratureThere are only a few case reports on RSIs among various surgical branches. The data is inconclusive and there is little evidence in the literature that relates to spinal surgery.MethodsThis retrospective study was conducted at Indian Spinal Injuries Centre. The data was collected from hospital records ranging from January 2013 to December 2017. The surgical cases in which cottonoid counts were inconsistent during or after the procedure were included in the study. The case files along with operating theater records were thoroughly screened for selecting those in which there was confirmed evidence of such an event.ResultsThere were 7,059 spinal surgeries performed during the study period. Fifteen cases of miscounts were recorded with an incidence of one in every 471 cases. Cottonoids were most commonly lost under the shoes of the surgeon or assistants. In two instances, cottonoids were found in the surgical field and trapped in the interbody cage site. Based on these locations, a systematic search algorithm was createdConclusionsThis study enumerates RSI risk factors in spinal surgical procedures and describes steps that can be followed to account for any missing cottonoids. The incidence of missing cottonoids can be decreased using a goal-oriented approach and ensuring that surgical teams work in collaboration.

A perioperative overview of a retained surgical swab in spinal surgery: Case report and prevention protocol

“…Our case report attempts at eliminating the occurrence of RSS to prevent the unplanned return to theatre and reduce potential harm to the patient (Rowlands 2012). As early as 1892, with the first case report in a French journal, to an increasing number of reports in the early 2000s, the awareness of RSS has grown as many authors have attempted to reduce its occurrence employing various strategies, which are now standard protocol including repeating the surgical count prior to wound closure, algorithms, radio-opaque strips to allow easy identification and utilising separate staff to count surgical swabs (as far back as 1901) (Atabey et al 2009, Freitas et al 2016, Neugebauer 1901, Reddy et al 2019). New technologies such as ‘Electronic Computer Assisted Sponge Counting System’ and Radio-Frequency identification (RFID) sponges have become useful in reducing the incidence of RSSs (Rupp et al 2012, Williams et al 2014).…”

“…Textilloma are mass lesions consisting of the surgical swab whereas Gossypiboma is used to describe both the swab mass as well as the surrounding foreign-body reaction (Akpinar et al 2015). ‘Never events’ cause physical, emotional and financial burden to the patient, and can similarly profoundly impact the surgical team emotionally and lead to punitive financial costs (Bilali et al 2019, Hempel et al 2015, Kim et al 2007, Rajput et al 2003, Reddy et al 2019). The incidence of RSSs in 2021/22 in the United Kingdom was 21 out of 98 retained surgical objects and estimated to be 1 in 10,000 for all surgical procedures (Alemu & Tiruneh 2020, NHSI 2022).…”