Value of Technology to Prevent Retained Surgical Items: Q&A With Dr. Christopher Rupp of UNC Hospitals

Christopher Clarence Rupp, MD, is a surgeon at University of North Carolina Hospitals. He serves as the principal investigator of an ongoing multi-institution study examining the use of radio-frequency detection technology as an adjunct to the standard practice of manual counting to prevent retained surgical items. Dr. Rupp presented results of the study (pdf) at the ACS Clinical Congress in October, with key interim conclusions including the following:

  • RF detection can speed identification and avoid use of radiation to locate missing sponges, thereby improving both patient safety and clinical workflow efficiency in the operating room.
  • Retained foreign objects occur regardless of whether the manual counts were correct, affirming the need for a check-and-safety balance with adjunctive detection technology,
  • In almost 90 percent of operations, nursing staff reported that radio-frequency detection offered less stress during wound closure and improved overall confidence that no foreign objects were left in the patient.


Q: Why is the prevention of retained surgical objects an important issue to you?


Dr. Christopher Rupp: Retained surgical items are a preventable event that many surgeons experience during their careers. This incident can have a variety of negative results. For patients, it can cause post-procedure infection, bowel perforation, pain, even death. For providers, it often means follow-up procedures and expenses and legal issues.


Laparotomy sponges in particular can be very difficult to identify and recover during prolonged and complex operations. This, in addition to the fact that our population is becoming more obese, adds to the complexity of caring for patients. Retained surgical items are especially a concern during bariatric procedures, as patients with higher body mass index are at greater risk.


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Q: Why do you believe it is necessary to use technology to help surgical teams prevent and detect retained foreign objects in surgery? Where can manual counting by operating room personnel, the standard-of-care in preventing retained objects, come up short?


CR: Operating room personnel are a highly trained group of individuals who are very good at what they do. However, they are "human" and are subject to the same errors that all of us are capable of when it comes to counting. Taking a very simple task, such as counting, and placing it in a complex situation with several competing events occurring exponentially increases the chance for error. Technological adjuncts are designed not to replace well-established counting protocols, but to assist in the identification of retained surgical items and make the operating room a safer environment.


Q: What do you see as the benefits of the use of radio-frequency detection technology?


CR: In-vivo detection lends itself to quick and efficient identification of retained surgical items. While ultimately the benefit is to prevent any retained surgical items from occurring, it also allows the operating room personnel to quickly locate an item and truncate a potentially prolonged search while the patient is under anesthesia.


Q: How does the use of this technology help support the work you do as a surgeon?


CR: It ultimately helps protect our patients from errors and work towards the same goal of optimal care of our patients.


Q: What could you see as a reason why organizations have not integrated this technology into their operating rooms, and what would you say in response to these considerations?


CR: The use of technological adjuncts have not been mandated by our governing agencies yet, but many organizations have deemed retained surgical items as a "never event," meaning they are part of a list of events in the operating room and patient care in general that are not acceptable and will potentially have financial and professional repercussions. Adoption of the technology is really still in its infancy and, given time, I think this will become common practice in all operating rooms in the United States and elsewhere.


Thank you to RF Surgical for arranging this interview.


Related Articles on Retained Objects:

Understanding and Preventing Retained Surgical Items: Q&A With Dr. Jeffrey Port of RF Surgical Systems

Indiana State Report Reveals Pressure Ulcers Top List of Hospital-Acquired Conditions in 2010

Education Does Little to Curb Retained Objects During Surgery, Additional Interventions Needed

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