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Canadian surgeons more likely to leave sponges, knives inside patients

Canada ranks one of the highest nations in the developed world for post-surgery 'foreign bodies' left in patients. Wikimedia Commons

If you undergo surgery in Canada the chance of a doctor leaving a scalpel or sponge in you is higher than it is in most developed nations in the world, according to a report.

The Organisation for Economic Co-operation and Development (OECD) reviewed the highest incidence of “foreign bodies” left inside a patient post-surgery.

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The most current data dates back to 2015. It shows Canada falls in the bottom quarter of the 20 OECD countries. The rate of a foreign object — such as a sponge, towel or scalpel — left in during a procedure happens 8.6 times for every 100,000 hospital discharges in Canada. Compare this with OECD average of five per 100,000.

“The most common item left behind is a sponge,” Katerina Gapanenko with the Canadian Institute for Health Information (CIHI) said.

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“Other items are fragments of a device or surgical tools.”

Canada performs below nearly all of its peers, with the exception of Switzerland, New Zealand and Australia. Surgeons in countries such as the U.S. and Sweden, leave half as many foreign objects in their patients per 100,000 discharges.

Gapanenko said some surgeries do require tools to be purposefully left behind in a patient, but this data does not include that.

Despite the fact that these rates are low, around 165 of these preventable events occur each year in Canada, according to the CIHI.

These foreign objects may cause internal hemorrhaging, infections and other complications including death, Sandi Kossey, senior director at the Canadian Patient Safety Institute, said.

“The impact can be catastrophic,” Kossey said. “They don’t happen frequently, but they should never happen at all,” Kossey said.

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The Canadian Patient Safety Institute created a list of “never events” in surgery — incidents that result in serious patient harm or death and are preventable using organizational checks and balances. Unintended foreign objects left in a patient following a procedure is third on the list (out of 15 incidents).

Quebec worst province

The OECD also looked at data on the number of foreign bodies left in patients after surgery in Canada. Quebec was not only the worst in the country, but also ranked the lowest out of all the OECD countries. The rate of a foreign object left in after surgery happens 13.2 times for every 100,000 hospital discharges Quebec.

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Manitoba ranked the second worst in the country as well as all OECD nations. It had a rate of 11.8 out of 100,000. Switzerland came in third with a rate of 11.6 out of 100,000.

Solutions?

The likelihood of these events increases when surgical teams are tired and distracted due to lengthy, late or multiple procedures, Gapanenko said. It’s also likely to happen when procedures have multiple teams, she said.

“Operating rooms are incredibly complex and the stakes are high,” Kossey said.  She said a lot of reasons these sometimes fatal errors happen in surgery rooms is because of a lack of teamwork and communication.

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“There should be counting and double counting, trusting your gut instincts and speaking up when you feel something is off,” she said.

Using a surgical team checklist can reduce the number of these patient safety incidents, and most surgery teams in Canada use this, she said.

But more can be done, such an introducing bar-coded sponges, she said. The bar-code sponges have shown to prevent leaving them in patients, according to the CIHI.

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