Retained Surgical Items in Korea: A Systematic Review

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Purpose: Retained surgical items (RSIs), such as gauze, sponges, instruments, or devices inadvertently left in the body after surgery remain a preventable medical error despite advancements in surgical techniques and safety protocols. This review systematically analyzes the status of residual surgical foreign bodies reported in Korea.Methods: A comprehensive search was conducted in Koreamed, ScienceON, Medline, Embase, and Korean academic society journals using keywords such as “cottonoid,” “gossypiboma,” “textiloma,” “retained surgical item,” “instruments,” “needle,” “sponge,” “swab,” “retained foreign body,” and “object.” The internal validity of case reports was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.Results: A total of 66 RSI cases were identified across 55 studies. Female patients accounted for 54.5% of the study population, with a median age of 52.5 years. Pain was the most common symptom (39.4%), followed by palpable masses (19.7%) and discomfort (19.7%). The median time to detection was 4.5 years; 31.8% were discovered within one year, and 37.9% were detected after 10 years. Gauze was the most frequently retained item (56.1%), followed by sponges/towels (19.7%); catheter fragments (9.1%); and drains, tubes, and sutures (4.5% each). Most patients (84.8%) were treated surgically, with endoscopic procedures accounting for 13.6%.Conclusion: RSIs continue to be an undesirable surgical complication, underscoring the ongoing need for comprehensive and multifaceted prevention strategies. Because RSIs cannot be prevented solely through surgical counting systems, effective prevention requires multidisciplinary collaboration among surgeons, anesthesiologists, and nurses. Future research on RSI prevention strategies could play a crucial role in enhancing patient safety in hospitals.

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