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Evidence cited in the editorial estimates incidence around 1.3 per 10,000 inpatient operations, with earlier intra-abdominal reports as high as 1 in 1000–1500. Preventable harm spans morbidity, legal liability, emotional trauma, and documented severe outcomes up to death. Existing prevention relies on manual counting and the WHO Surgical Safety Checklist, but residual occurrences—including high rates despite “correct” counts and limited X-ray detection—support stronger system safeguards. The piece argues for mandatory adoption of technologies such as RFID, barcoding, computer vision, and imaging, while acknowledging resource constraints.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/retained-surgical-objects-preventable-never-events-and-the-case-for-mandatory-technology-adoption/435592/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/retained-surgical-objects-preventable-never-events-and-the-case-for-mandatory-technology-adoption/435592.png","ImageObject",300,407,{"name":92,"@type":93},"nayy☆","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What are retained surgical items (RSIs) and why are they considered “never events”?","Question",{"text":112,"@type":113},"RSIs include retained sponges, needles, and instruments. They are widely recognized as “never events” because they are preventable, yet they still occur at high rates worldwide.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do manual counting procedures and the WHO Surgical Safety Checklist fall short?",{"text":117,"@type":113},"Despite use of the WHO Surgical Safety Checklist and manual counts, RSIs can still occur, including cases reported as “correct” counts. Intraoperative X-ray alone detects only a portion of cases, indicating incomplete protection.",{"name":119,"@type":110,"acceptedAnswer":120},"What technology solutions does the editorial advocate for reducing RSIs?",{"text":121,"@type":113},"The editorial calls for mandatory adoption of technology such as RFID-embedded sponges, detection wands, 2D data-matrix barcoding, computer-vision tracking, and complementary postoperative imaging like CT, fluoroscopy, and ultrasound.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435592,1791710298,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},962090893153,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Editorial  \n# Retained surgical objects: preventable“neverevents”andthe case for mandatory technologyadoption\n\nArya Afrooghe, MDa,*, Elham Ahmadi, MDb  \nDear Editor,  \nRetained surgical items (RSIs), commonly sponges, needles,and instruments, are recognized as “never events,” yet they con -tinue to occur at alarming rates worldwide[1] . Contemporarystudies estimate the incidence of RSIs at approximately 1.3 per10 000 inpatient operations, with earlier data citing rates as highas 1 in 1000-1500 in intra-abdominal cases[2,3] . Sponges remainthe single most frequently retained surgical item and account forthe majority of reported retained surgical items[4] .  \nThese preventable errors carry significant consequences, ran -ging from patient morbidity and legal liability to emotionaltrauma for both patients and surgical teams[5] . Despite wide -spread adoption of safety tools like the world health organiza -tion (WHO) Surgical Safety Checklist, which has been linked toup to a 38% reduction in perioperative mortality and proceduralcomplications, RSIs still occur[6] . This exposes the limitations ofprotocol-based approaches alone.  \nHigh-risk scenarios, such as emergencies, unexpected proce -dural changes, and operations involving overweight patients, areparticularly vulnerable to counting errors and lapses incommunication[2] . These system failures persist even when manualsponge counts are reportedly“correct. ” This underscores the needfor stronger safeguards beyond checklists and human vigilancealone. No generative artificial intelligence (AI) tools were used inthe creation of this manuscript’s content. All intellectual contentwas conceived, written, and critically revised by the authors inaccordance with the TITAN Guidelines 2025[7] .  \nRSIs inflict measurable harm and cost. Large-scale descriptiveanalyses (n = 319 events over 5 years) highlight that spongesalone constitute >50% of RSIs. This is predominantly observed  \naExperimental Medicine Research Center, Tehran University of Medical Sciences,Tehran, Iran and bSchool of medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran  \nSponsorships or competing interests that maybe relevant to the content aredisclosed atthe end of this article.  \n*Corresponding author. Address: Experimental Medicine Research Center, Faculty ofMedicine, Tehran University ofMedical Sciences, Poursina St, Keshavarz Blvd, Tehran1417613151, Iran. Tel.: +98 9120463032. E-mail: aryaafrooghe99@gmail.com(A. Afrooghe).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the terms of the Creative CommonsAttribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where itispermissible to download and share the work provided itis properly cited. The workcannot be changed in any way or used commercially without permission from thejournal.  \nAnnals of Medicine & Surgery (2026) 88:9–12Received 30 July 2025; Accepted 4 November 2025Published online 17 November 2025http://dx.doi.org/10.1097/MS9.0000000000004329  \nin abdominal/pelvic cases. The survey also revealed that 14% ofRSIs resulted in severe temporary harm, with one case leading topatient death[8] . A broader outcome study of over 1100 RSIevents reported mortality in 4.5% of cases, permanent physicalinjury in 16.3%, and temporary harm in 78.1% . Psychologicalsequelae were also documented in this study [5] . In addition,litigation costs reveal a mean compensation of approximately€20 700 per RSI event, and a twofold higher risk of criminalproceedings compared to othermalpractice claims in a Florencehospital series[9] . These figures underestimate reality, as RSIs arefrequently underreported due to delayed detection or fear oflegal consequences[10] . Thus, the global burden of RSIs extendsbeyond statistics to include emotional trauma and shatteredtrust in health care systems.  \nCurrent prevention depends heavily on manual counting pro -cedures and the WHO Surgical Safety Checkl","cbCaioHSzffxrhX0","https://ap.wps.com/l/cbCaioHSzffxrhX0","pdf",763300,"English","# Retained surgical items as preventable “never events”\n## Incidence, common items, and consequences\n## Limitations of checklist and manual counting\n## High-risk scenarios and human factors\n## Technologies moving from optional to essential\n## Implementation barriers and resource considerations","[{\"question\":\"What are retained surgical items (RSIs) and why are they considered “never events”?\",\"answer\":\"RSIs include retained sponges, needles, and instruments. They are widely recognized as “never events” because they are preventable, yet they still occur at high rates worldwide.\"},{\"question\":\"How do manual counting procedures and the WHO Surgical Safety Checklist fall short?\",\"answer\":\"Despite use of the WHO Surgical Safety Checklist and manual counts, RSIs can still occur, including cases reported as “correct” counts. Intraoperative X-ray alone detects only a portion of cases, indicating incomplete protection.\"},{\"question\":\"What technology solutions does the editorial advocate for reducing RSIs?\",\"answer\":\"The editorial calls for mandatory adoption of technology such as RFID-embedded sponges, detection wands, 2D data-matrix barcoding, computer-vision tracking, and complementary postoperative imaging like CT, fluoroscopy, and ultrasound.\"}]","Retained surgical objects: preventable “never events” and the case for mandatory technology adoption | PDF",1790674336]