The Hidden Costs of Reconciling the Surgical Sponge Count

Purpose:
The objective of this study was to estimate the cost of nonproductive operating room time reconciling a surgical sponge count and the cost of using radiography to rule out the presence of retained sponges.

Background/Significance:
Retained surgical sponges are serious adverse events that can result in negative patient outcomes. The primary method of prevention is the sponge count. The process of searching for sponges to reconcile counts can result in inefficient use of operating room time. For high risk patients, an intraoperative radiograph is often obtained. These costs are usually not reimbursed.

Methods:
For this descriptive study, we conducted a retrospective review of surgical procedures in a large, academic medical center during a nine month period. Data were recorded by circulating nurses and retrieved from the HIS documentation system and the Patient Safety Net electronic event reporting system. The cost per minute of operating time and a radiograph were determined using published data to enhance generalizability. Descriptive statistics were used to describe the number of surgical procedures and their duration, and the number of searches and their duration and costs. We analyzed data in aggregate and by surgical service.

Results:
We included 13,322 patient surgeries. Additional time (1-90 minutes) was required for reconciliation of 212 sponge counts. The missing surgical sponge(s) were located 87.8% of the time. 52 of the patients received intraoperative radiographs to rule out the presence of a retained sponge. The total annualized cost of nonproductive operating room time searching for sponges and ruling out the presence of potentially retained sponges using radiography was $219,056.

Conclusions and Implications for Practice:
Time spent reconciling the sponge count can be significant and takes time and attention away from the surgical procedure and other high priority tasks in the operating room. The cost of this time should be included in cost analyses when considering adjunct technology to supplement manual counting.