How Many People Work In Your Operating Room? An Assessment of Factors Associated with Instrument Recounts Within Plastic Surgery

Publication date: Available online 28 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Derek D. Reformat, Joshua A. David, J. Rodrigo Diaz-Siso, Natalie M. Plana, Annie Wang, Nicholas D. Brownstone, Daniel J. Ceradini
BackgroundIntra-operative instrument recounts are performed in order to avoid retained foreign surgical items. These additional counts, however, beget risks of their own; including prolonged operative times, exposure to radiation, and increased cost. Our study aimed to identify factors that increase the likelihood of instrument recounts during plastic surgery procedures, and use our findings to guide potential solutions for preventing unnecessary recounts across all surgical fields.Study DesignThis is a retrospective review of all plastic surgical cases in the main operating setting at New York University Langone Medical Center (NYULMC) between March 2014 and February 2015.ResultsOf 1285 plastic surgery cases, 35 (2.7%) reported a missing instrument necessitating a recount. Of all sub-specialties within plastic surgery, only microsurgery conferred an increased risk of a recount event. We identified multiple factors that increased the odds of a recount event, including increased operative time, number of surgical sites, and intra-operative instrument hand-offs.ConclusionInstrument recounts, although designed to prevent inadvertently retained surgical items, present inherent risks of their own. In a large retrospective review of plastic surgery cases at our medical center, we identified many factors that increased the likelihood of an instrument recount. Based on our findings and prior literature, we recommend limiting the number of staff handling instrument, the number of hand-offs, and a heightened awareness by surgeons and peri-operative staff of specific procedures and risk factors that increase the risk of a miscount event.



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