Lost and found: trends in litigation and compensation related to retained surgical foreign bodies

Simone Grassi Martina Focardi ^* Francesco Santori Marta Guerini Elisa Ferri Giulia Ferretti Ilenia Bianchi Filomena Autieri Vilma Pinchi

• University of Florence, Florence, Italy

Introduction : Retained surgical foreign bodies are supplies and devices unintentionally left in the surgical site. They are generally considered never events, albeit even full compliance with procedures can only contain the risk of their occurrence. As never events, interested patients tend to allege gross negligence and hospitals are often forced to compensate for the damages. Despite the physical consequences of the retention are usually mild and temporary and thus the paid compensations may be hypothesized to be correspondently low, clear data about the medico-legal outcome of these claims in terms of extrajudicial/judicial evolution and of mean compensation have not been described yet. Materials and methods : In this paper, a retrospective study on the related claims received from January 1, 2010 to May 30, 2024 by a large university hospital in Florence (Italy) was performed to deduce their incidence and mean costs, together with the risk that medical malpractice claims correspond to criminal complaints. Results : We found 27 eligible cases with a mean compensation of 20,695.49 €. In the same-period claims unrelated to retained foreign bodies, used as controls, were associated with a 67,542.26 € mean compensation. Considering only non-fatal events, criminal lawsuits were present in 12% of the cases respect to 6% of the control samples which fell in the same compensation range. Most cases (63%) were directly managed by the hospital, but in lower percentage compared to control cases (76%). Discussion : In conclusion, even if the economic dimension of the claims related to retained surgical foreign bodies is relatively contained, they are associated with a two-fold risk of criminal lawsuit for doctors and patients are less confident in out-of-court settlement provided directly by the hospital committees compared to judicial court trials. This indicates that patients perceived a RSFB as never event, which deserves less justification compared to other wrongful medical cares, being likely driven by a breach of trust in doctors and hospital rather than the entity of the consequences that are normally mild or limited to temporary impairment.