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Sponge Tracking by Bar Code or Radio Frequency Can Be Cost Effective: Presented at ACS

By Roberta Friedman, PhD

SAN FRANCISCO -- October 21, 2008 -- Surgical sponges can be tracked by bar coding and with radio-frequency tags to help keep them from being left behind in patients after surgery. Both methods are superior to universal x-ray or simply counting sponges before and after surgery, according to a study presented here at the American College of Surgeons (ACS) 94th Annual Clinical Congress.

Institutions can use the models presented to decide if the extra expense of tracking sponges with new technologies is worth the goal of preventing any case of a retained sponge, said presenter Scott Regenbogen, MD, MPH, Department of Health Policy and Management, Harvard School of Public Health, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Dr. Regenbogen and his colleagues carried out a randomised, controlled study with bar-coded sponges in 298 patients and compared the sponge retention rate with that in an observational study of 191,168 surgeries and to clinical experience with bar-coded sponges in a separate 60,000 cases. The researchers estimated outcomes from radio frequency sponge tracking using 2 models based on differing assumptions.

The estimate is that, without any effort to count sponges, they will be left behind in 67 per 100,000 surgeries, he said in a presentation on October 13. Simply counting sponges before and after surgery prevents 82% of these incidents, the investigators noted.

Radio-frequency tagging would prevent 97.5% to 99.7% of cases of retained sponges, adding approximately $630,000 to $719,000 in cost per each averted event, depending on the 2 respective models' assumptions. Bar coding the sponges avoids nearly $94,500 in cost per event, preventing 97.5% of cases of a sponge left in a patient.

The researchers concluded that universal x-ray is more costly but less effective than either bar coding or radio-frequency tagging. X-ray avoids 95.5% of sponges left behind and adds approximately $1.3 million for each avoided incident. Dr. Regenbogen said universal x-ray is not cost effective or reliable.

"Hospitals are going to have to decide how much they are willing to pay" for strategies to avoid missing a sponge during surgery, Dr. Regenbogen said. "We are hoping that the price of these technologies will come down."

Funded for this study was provided by SurgiCount Medical.

[Presentation title: Novel Strategies to Prevent Retained Surgical Sponges: A Decision-Analytic Model Predicting Relative Cost-Effectiveness. Abstract S73]

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