Pediatric Medical Errors Most Likely in Gynecologic, GI Surgeries

Cheryl Clark, November 24, 2010

Surgical teams leaving tools or other foreign bodies inside pediatric patients is a serious medical error that is most common in gynecological surgeries adds to the cost and duration of a child's hospital stay, but not to mortality rates.

That's the conclusion from researchers at Johns Hopkins University, who studied a national database of 1,946,831 operations in children over 17 years, and in 36 states, and found 413 incidents in which sponges or other surgical instruments were unintentionally left, requiring follow-up procedures to remove them.

"Among pediatric surgical admissions, a foreign body left during a procedure was observed to occur with highest likelihood during gynecologic operations," said the article, by Melissa Camp, MD, principal investigator at Johns Hopkins University School of Medicine.  However the greatest numbers, or highest proportions of such cases occurred in patients with gastrointestinal surgery (21.52%), followed by cardiothoracic (16.14%) and orthopedic (12.97%) procedures.

"Because gynecologic procedures had the highest odds ratio for retained foreign body, a subset analysis was performed that revealed that 15 of 17 patients had ovarian cyst or cancer-related procedures, 1 of 17 had a cesarean section, and 1 of 17 had a procedure for pelvic adhesions," the authors wrote.

"It's important to find out what mistakes we make as surgeons, but it is infinitely more important to know why we're making them and how we can prevent them," says principal investigator Fizan Abdullah, M.D., a pediatric surgeon at Johns Hopkins and one of the authors of the report.  The research was published in the November issue of the Archives of Surgery.

"This finding has significant cost and morbidity implications because patients with PDI 3 (a Pediatric Quality Indicator classification representing surgical foreign body retention) were shown to have a longer length of stay and greater total hospital charges compared with patients without PDI 3," the authors wrote.

However, mortality did not differ between those who had a foreign body retained and those who did not.

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