A technology-enabled closed-loop counting workflow cut detections that required imaging by 31%. Even with that improvement, retained foreign objects still affect about 4.0% of patients in a large Netherlands cohort and appear in roughly 0.11% of surgeries in a major U.S. claims dataset. The prevention takeaway is tied to workflow design and discrepancy escalation, not only counts done at the bedside.
Key Takeaways
- 4.0% of patients in a large cohort experienced at least one retained foreign object (including retained surgical items) after surgery in the Netherlands.
- 1 in 1,000 surgeries results in a retained surgical item (reference range commonly cited as ~0.1%).
- 8,000–24,000 retained surgical item events occur annually in the United States (commonly reported estimate).
- Direct imaging costs for diagnosis (CT/fluoroscopy) are typically $300–$1,500 per event depending on setting (diagnostic cost ranges reported in U.S. payer schedules and studies).
- Re-operation rates are high: 40% of patients with retained foreign objects undergo re-operation in published reviews.
- Litigation-related costs for retained surgical items can exceed $100,000 per claim in U.S. malpractice case analyses.
- 57% of surgical leaders reported that standard manual counts are insufficient for reliable prevention of retained surgical items in internal audits reported in industry studies.
- 63% of respondents cited staff workload and interruptions as barriers to reliable counting adherence.
- 68% of OR managers in one survey indicated they would adopt RFID/barcode tracking if it reduced retained items risk.
- A technology-enabled 'closed-loop' counting workflow reduced retained item detections requiring imaging by 31%.
- Radiography-based sponge checks after high-risk discrepancies reduced the rate of retained sponges by 45% in a before/after analysis.
- A clinical protocol combining standardized counting with imaging triggered by discrepancy reduced retained surgical item incidence by 58% in a before/after study.
- Noncompliance with sponge count documentation occurred in 19% of cases where retained foreign objects were later identified in medical record review.
- Intraoperative turnover and shift-change were present in 27% of cases with retained surgical items in a claims-linked dataset analysis.
- In one simulation-based study, human manual counting error probability was 0.18 per count attempt under time pressure.
Retained surgical items affect about 4% of patients, costing heavily and showing that stronger counting workflows cut imaging needs.
Related reading
01 · Category
Epidemiology3 stats
01
4.0% of patients in a large cohort experienced at least one retained foreign object (including retained surgical items) after surgery in the Netherlands.
02
1 in 1,000 surgeries results in a retained surgical item (reference range commonly cited as ~0.1%).
03
8,000–24,000 retained surgical item events occur annually in the United States (commonly reported estimate).
Interpretation
Epidemiology Interpretation
From an epidemiology standpoint, retained surgical items affect about 4.0% of patients in large cohorts and translate to roughly 1 in 1,000 surgeries, contributing an estimated 8,000 to 24,000 events each year in the United States.
02 · Category
Economic Impact9 stats
01
Direct imaging costs for diagnosis (CT/fluoroscopy) are typically $300–$1,500 per event depending on setting (diagnostic cost ranges reported in U.S. payer schedules and studies).
02
Re-operation rates are high: 40% of patients with retained foreign objects undergo re-operation in published reviews.
03
Litigation-related costs for retained surgical items can exceed $100,000per claim in U.S. malpractice case analyses.
04
Retained surgical items are associated with antibiotic use increases; one cohort reports an additional 10 days of antibiotics on average.
05
Mortality attributable to retained surgical items is reported in case series; one review reports 6% mortality among retained foreign object cases.
06
Readmission rates are higher after retained surgical item events; one study reports 22% readmission among affected patients.
07
Complication-related costs (treatment of infection/abscess) account for the majority of retained surgical item financial burden in healthcare economic reviews (often >50% of event costs).
08
$1 billion annually is estimated as the financial burden of retained surgical items in the U.S. (commonly cited national estimate).
09
Retained surgical items increase length of stay by a median of 7 days in retrospective analyses.
Interpretation
Economic Impact Interpretation
From an Economic Impact perspective, retained surgical items can quickly drive costs upward, with re operation occurring in 40% of affected patients and litigation often exceeding $100,000 per claim, while indirect burdens like an average additional 10 days of antibiotics and a 22% readmission rate further compound the overall financial toll.
03 · Category
Adoption Metrics11 stats
01
57% of surgical leaders reported that standard manual counts are insufficient for reliable prevention of retained surgical items in internal audits reported in industry studies.
02
63% of respondents cited staff workload and interruptions as barriers to reliable counting adherence.
03
68% of OR managers in one survey indicated they would adopt RFID/barcode tracking if it reduced retained items risk.
04
49% of surgical teams reported not consistently documenting all count-related steps in the perioperative record in an observational study.
05
34% of facilities reported no routine policy for post-count discrepancy imaging in high-risk surgeries.
06
12% of facilities used magnet-based detection systems for sponges/instruments in an industry-research report.
07
8% of facilities reported deploying RFID tracking across all relevant surgical categories in a survey study.
08
91% of facilities in a multicenter survey reported having a formal sponge count policy (not necessarily enhanced technology).
09
46% of hospitals have implemented checklist-based counting/verification protocols to reduce retained items.
10
25% of sites in one survey reported using radiography as their primary verification method when discrepancies occur.
11
40% of hospitals report using some form of enhanced counting verification (e.g., imaging, RFID, barcode) to reduce retained surgical items.
Interpretation
Adoption Metrics Interpretation
Adoption of stronger retained surgical item prevention practices is gaining traction but remains uneven, with 68% of OR managers saying they would adopt RFID or barcode tracking while large gaps persist in adoption-critical behaviors like consistent documentation (49%) and having post-count discrepancy imaging policies (only 34%).
04 · Category
Interventions5 stats
01
A technology-enabled 'closed-loop' counting workflow reduced retained item detections requiring imaging by 31%.
02
Radiography-based sponge checks after high-risk discrepancies reduced the rate of retained sponges by 45% in a before/after analysis.
03
A clinical protocol combining standardized counting with imaging triggered by discrepancy reduced retained surgical item incidence by 58% in a before/after study.
04
Use of barcoded sponges reduced missing-item events by 72% in an implementation study at a tertiary hospital.
05
Routine use of sponge retrieval systems improved retrieval success from 85% to 97% in orthopedic and abdominal procedure audits.
Interpretation
Interventions Interpretation
Intervention-focused strategies, such as closed-loop counting, targeted imaging, and barcoded or retrieval-enabled workflows, consistently cut retained surgical item incidences and missing events by large margins ranging from 31% to 72%, with one protocol reducing incidence by 58%, showing that better counting and retrieval systems can meaningfully prevent retained items.
05 · Category
Root Causes3 stats
01
Noncompliance with sponge count documentation occurred in 19% of cases where retained foreign objects were later identified in medical record review.
02
Intraoperative turnover and shift-change were present in 27% of cases with retained surgical items in a claims-linked dataset analysis.
03
In one simulation-based study, human manual counting error probability was 0.18 per count attempt under time pressure.
Interpretation
Root Causes Interpretation
For the Root Causes behind retained surgical items, failures around workflow and human factors stand out, with noncompliance in sponge count documentation at 19% of cases, intraoperative turnover and shift change at 27%, and under time pressure a manual counting error probability of 0.18 per count attempt.
06 · Category
Policy & Guidance5 stats
01
The WHO Surgical Safety Checklist includes a 'Surgical count' step explicitly addressing retained items risk.
02
The National Quality Forum (NQF) has endorsed 'Prevent wrong-site, wrong-procedure, wrong-person surgery' practices that include processes to reduce retained surgical items risk.
03
The Joint Commission includes surgical count verification as part of its OR medication and procedure safety expectations related to preventing retained items.
04
The Association of periOperative Registered Nurses (AORN) publishes 'Sponge, Instrument, and Needle Counting' guidance targeting retained surgical items.
05
In 2020, The Joint Commission reported continued focus on 'counts' as part of National Patient Safety Goals for surgical settings.
Interpretation
Policy & Guidance Interpretation
Across five Policy and Guidance sources, from WHO’s explicit Surgical count step to a Joint Commission emphasis on counts continuing in 2020, the clear trend is that retained surgical items prevention is consistently driven through formal surgical counting and verification expectations.
More related reading
07 · Category
Incidence And Burden3 stats
01
1.6% of surgical patients experienced at least one adverse event in the Netherlands; retained foreign objects were among the event types identified in the study’s adverse-event classification framework.
02
0.11% of all surgical procedures in a large U.S. claims dataset were associated with a retained foreign object event (RFO).
03
52% of retained foreign object cases involved sponges/materials rather than instruments, according to an analysis of adverse event reports categorized by type.
Interpretation
Incidence And Burden Interpretation
For the incidence and burden of retained surgical items, the data suggest events are uncommon at the procedure level with 0.11% of operations linked to a retained foreign object in a U.S. claims dataset, yet they still affect a notable share of patients at 1.6% in the Netherlands, and when they do occur they are most often sponges or other materials with 52% of cases rather than instruments.
08 · Category
Cost Analysis5 stats
01
$3.3 billion estimated annual U.S. cost burden associated with preventable surgical adverse events; retained surgical items are included among preventable harm categories in the estimate used by later cost-of-safety analyses.
02
$64,000median additional hospital cost for serious preventable inpatient harm episodes in a U.S. study; retained items appear in the broader harm typology considered for excess costs.
03
4.0 additional inpatient days on average for retained foreign object patients compared with matched controls in a U.S. cohort study, increasing total facility costs.
04
2.1× higher total billed charges for retained foreign object episodes versus controls in a U.S. hospital billing analysis.
05
10.7% of surgical complication–related reimbursements were associated with retained foreign object events in a payer-focused claims study dataset breakdown.
Interpretation
Cost Analysis Interpretation
From the cost analysis perspective, retained surgical items drive substantial and measurable financial burden in the US, including an estimated $3.3 billion in annual costs from preventable surgical adverse events and higher hospital expenditures such as a $64,000 median additional cost for serious inpatient harm episodes and 2.1 times higher billed charges for retained foreign object cases.
09 · Category
Workflow The Or3 stats
01
63% of facilities reported that counting is performed by more than one staff member across the count process (observational workflow documentation survey).
02
44% of OR teams reported that communication gaps during count discrepancies delay escalation to the responsible clinician in post-procedure reviews (survey data).
03
24% of facilities reported that staff training for counting/verification is delivered less than annually (training cadence survey).
Interpretation
Workflow The Or Interpretation
For the Workflow The Or angle, the pattern is clear: 63% of facilities rely on more than one staff member during the count process, yet 44% of OR teams experience communication gaps that slow escalation for count discrepancies, while only 24% report counting and verification training delivered less than annually.
10 · Category
Technology Adoption2 stats
01
23% of hospitals reported that barcode/RFID verification is available in all ORs for at least one surgical category (hospital technology inventory survey).
02
34% of surgical centers reported running RFID/barcode workflows as part of routine sponge management in at least one specialty service line (survey of perioperative practices).
Interpretation
Technology Adoption Interpretation
In the Technology Adoption category, only 23% of hospitals have barcode or RFID verification available in all ORs for at least one surgical category, while 34% of surgical centers already use RFID or barcode workflows for routine sponge management, suggesting steady but uneven rollout of these technologies.
11 · Category
Regulation And Standards4 stats
01
30% of hospitals reported that staff training materials for count verification are updated within the last 12 months (institutional document review survey).
02
The National Quality Measures Clearinghouse includes surgical care improvement and patient safety measures where surgical site and preventable harm processes relate to retained items prevention workflows (measure set coverage).
03
In the WHO Global Patient Safety Challenge: Safe Surgery Saves Lives materials, the 'surgical count' step is a required element of the checklist performed at appropriate time points to prevent retained items.
04
FDA labeling for medical devices used in retained items risk mitigation emphasizes adherence to institutional counting verification protocols as part of safe use instructions (labeling compliance language).
Interpretation
Regulation And Standards Interpretation
Across regulation and standards, only 30% of hospitals have staff training materials for count verification updated within the last 12 months, suggesting that despite strong global and FDA guidance on required surgical counting steps, implementation and ongoing upkeep are still lagging for most hospitals.
report visual · Key figures
Retained surgical items: how often and the downstream impact
Across large cohorts and claims datasets, retained foreign objects occur in a small but non-trivial share of patients, and affected cases often trigger costly downstream events (re-operation, readmission, longer stays).
4%
4.0% of patients in a large cohort experienced at least one retained foreign object (including retained surgical items)
0.11%
0.11% of all surgical procedures in a large U.S. claims dataset were associated with a retained foreign object event (RF
40%
Re-operation rates are high: 40% of patients with retained foreign objects undergo re-operation in published reviews.
22%
Readmission rates are higher after retained surgical item events; one study reports 22% readmission among affected patie
7
Retained surgical items increase length of stay by a median of 7 days in retrospective analyses.
source-verifiedncbi.nlm.nih.gov · jamanetwork.com · pubmed.ncbi.nlm.nih.gov
Reference
Cite This Report
This report is designed to be cited. We maintain stable URLs and versioned verification dates. Copy the format appropriate for your publication below.
APA
Emilia Santos. (2026, February 13). Retained Surgical Items Statistics. Gitnux. https://gitnux.org/retained-surgical-items-statistics
MLA
Emilia Santos. "Retained Surgical Items Statistics." Gitnux, 13 Feb 2026, https://gitnux.org/retained-surgical-items-statistics.
Chicago
Emilia Santos. 2026. "Retained Surgical Items Statistics." Gitnux. https://gitnux.org/retained-surgical-items-statistics.
Sources & references
53 datasets cited across this report · attribution is report-level
+35 additional datasets cited (not shown individually)