Retained surgical items

The National Quality Forum’s 2025 list of serious reportable events covers any unintended retention of a medical or surgical item after the surgery or invasive procedure ends, after completion of skin closure, regardless of whether the patient is still in the procedure room under anesthesia (opens in a new tab).

That list was rewritten in 2025. It now says medical or surgical item where it used to say foreign object, and it also includes instances when the clinical care team decides to leave the object in place or removal is delayed (opens in a new tab).

Illinois’s rule on reporting such events to the State keeps the older wording and excludes objects intentionally left in when the risk of removal exceeds the risk of retention (opens in a new tab). The State says reporting under that rule is not yet active (opens in a new tab).

An implant is different. The Forum excludes items intentionally implanted with documented consent (opens in a new tab), along with items intended to release on their own and items placed to stay in for a time, such as packing. Packing that is later not removed does count.

Count what goes in and what comes out, and look before closing. As a primer on the Agency for Healthcare Research and Quality’s Patient Safety Network describes the practice, nurses and surgical technologists perform multiple surgical counts at specified times (opens in a new tab). Surgeons do not count, it says, and their part is a wound examination before completing the operation (opens in a new tab).

Federal guidance for hospitals that take Medicare says a hospital’s policies on surgical care should contain the requirement to conduct surgical counts in accordance with accepted standards of practice (opens in a new tab), though the regulation behind it does not mention counts.

The American College of Surgeons recommends consistent application of standardized counting procedures and a methodical wound exploration before closure (opens in a new tab), with X-ray or other detection technology as indicated. It says its statement does not constitute a standard of care (opens in a new tab).

Illinois’s rule on hospital surgical policies speaks of surgical privileges, maintenance of the operating rooms, and evaluation of the surgical patient (opens in a new tab). It does not mention counts.

These are the documents of regulators and of the profession. What careful practice required in a particular operating room is for a qualified expert to explain. For the nurses’ count that means a nurse. An Illinois appellate court has noted that a physician who lacks a nurse’s license may not testify as an expert on the nursing standard of care (opens in a new tab).

Rarely. A 2015 review of studies put retained surgical items at 1 event per 10,000 procedures and said the precision is uncertain (opens in a new tab).

A hospital that looked harder found more. One institution that routinely X-rayed patients after operations in a body cavity found 34 retained objects among 191,168 operations from 2003 to 2006, about 1 in 5,500 (opens in a new tab). Twenty were identified on those routine films (opens in a new tab), and two patients left the hospital with an object.

A correct count does not settle it. In that study the count had been reported as correct in 21 of the 34 cases (opens in a new tab).

A caution applies to these figures. The second comes from one institution two decades ago, and the review calls its own estimate uncertain. Both count how often an item was left, and neither says how often that happened through carelessness.

The Illinois decisions on retained sponges described here come from the Appellate Court. They are not rulings of the Illinois Supreme Court.

An Illinois appellate court in Chicago has said that leaving a sponge in a patient’s body after surgery is prima facie evidence of medical negligence (opens in a new tab). Prima facie means enough to reach a jury unless it is answered. It is not a finding of fault.

The same court said the patient did not have to present an expert on the standard of care (opens in a new tab) in the claim against the hospital over its nurses’ sponge count.

Another Illinois appellate court held that the inference against a surgeon was negated by his undisputed testimony that he reasonably relied on the standard sponge-count procedure, including the nurses’ assurance that the final count was correct (opens in a new tab), where the patient had no admissible expert opinion against him.

Our page about Illinois malpractice law explains when an injury can itself be evidence of negligence, and the deadlines for a claim.

The count should leave a record. The American College of Surgeons says documentation should include the results of surgical item counts and the actions taken if count discrepancies occur (opens in a new tab).

A removed item may not come with a pathology report. Illinois hospital rules send tissue removed at surgery for pathological examination, with listed exceptions (opens in a new tab), and one exception is foreign substances removed during surgery, such as pieces of metal (opens in a new tab).

You can ask the hospital for your own records, and our Illinois law page explains how. If you were told that something was left inside, or had a procedure to remove it, write down the dates, who told you and what was said.