Study Counts Retained Surgical Items in Patients

What are the numbers and what is the cost to a hospital of retained surgical items (RSIs) during a total joint arthroplasty? And how many of these “never events” take place in a year? A study by Bryce Van Doren, a graduate research assistant at the OrthoCarolina Research Institute, Charlotte, North Carolina, as well as a doctoral student at the College of Health and Human Services, University of North Carolina at Charlotte came up with an answer.

Doren and his associates calculated that the rate of RSIs was one per 6, 878 primary total hip arthroplasties and one per 11, 961 total knee arthroplasties. The overall rate, according to Rosemary Frei, writing a report for Pain Management News, was one per 11, 948 procedures. They calculated the cost of a single retained item at $6, 412.

The patients who were unfortunate enough to experience an RSI underwent an average of one additional procedure than did those without an RSI. One doctor expressed surprise that the RSI rate was higher for knee replacements than it was for the hips. “There are not a lot of places for items to get out of sight in a knee, ” he observed.

The Centers for Medicare & Medicaid Services considers RSIs to be too serious to have a legitimate reason to occur. Therefore the agency does not reimburse hospitals or doctors for any costs associated with the incidents. Writers of the report suggested that this may lead to an under-reporting of the incidence of RSIs.

Frei quoted Robert Cima, M.D., professor of surgery and chair of the Surgical Quality and Safety Committee at Mayo Clinic in Rochester, Minnesota, who said that cost estimates are “particularly difficult to determine” and that the numbers reported are much lower than in his experience handling this issue over the last decade and in published reports.

“In many situations, the bills are written off by the institution, charges are adjusted and any payouts are usually associated with a confidentiality agreement, so the true costs of these events are unknown, ” Cima said.

Cima added that most orthopedic RSIs are not entire instruments but, instead, are small items such as the tip of a drill or a broken portion of a rod, plate or screw. Trying to remove these items from patients puts them at greater risk for complications than does leaving them in place.