Something Was Left Behind: What Happens When a Surgeon Forgets a Sponge or Instrument

You woke up from surgery, your incision healed, and you went home. But weeks or months later, something is wrong. You have unexplained pain, an infection that will not respond to antibiotics, and a swollen mass where there should not be one. In some cases, the cause turns out to be a retained surgical item, such as a sponge, clamp, needle, towel clip, or drain that was never removed before the surgical team closed the wound.

At Meyers, Rodbell & Rosenbaum, our DMV surgical malpractice lawyers have spent decades helping patients hold providers accountable for preventable surgical errors. A retained foreign object is one of the clearest examples of a failure that should never happen. Patients who suffer as a result have strong legal rights.

What Is a Retained Surgical Item?

A retained surgical item is any foreign object unintentionally left inside a patient's body at the conclusion of surgery. The most common examples include:

• Surgical sponges and gauze pads

• Instruments such as clamps, retractors, and hemostats

• Needles and suture materials

• Drain tubes and catheter fragments

• Towel clips and wire guides 

Surgical sponges are by far the most frequently retained items. They are soft, absorbent, and difficult to see in the body cavity once soaked with blood. Operating room staff must count all sponges, needles, and instruments before surgery begins and again before the wound is closed. When counts are inaccurate or missed, a sponge can remain inside a patient for months or years.

The Joint Commission classifies retained surgical items as sentinel events—serious, largely preventable patient safety failures that require full investigation. Despite awareness campaigns and better counting protocols, retained surgical items continue to cause serious patient harm every year.

Why Do Surgeons Leave Items Inside Patients?

Retained surgical items do not happen because surgeons are inherently careless. They happen because of systemic failures in operating room protocols, staffing, communication, and oversight.

Inaccurate Sponge Counts

Standard protocol requires surgical nurses to count all items before the procedure, after major phases of surgery, and before closing the wound. When a count is rushed, skipped, or miscommunicated between a rotating team, a sponge can disappear into the surgical field without anyone realizing it.

Emergency and Unplanned Surgeries

During high-urgency procedures, when a patient's life is at risk, staff may rush or bypass counting protocols. Studies show a higher rate of retained surgical items in emergency surgeries than in elective procedures.

Overweight Patients and Large Surgical Fields

Larger body cavities and deeper tissue planes make visual confirmation more difficult. A sponge can fall into a fold of tissue and remain invisible even when teams are actively looking.

Multiple Procedures or Team Changes

When surgical teams rotate mid-procedure or multiple surgeons operate on a patient, accountability for item counts can fall through the cracks. Handoffs are among the most dangerous moments in any complex medical procedure, as our overview of common types of medical malpractice cases in Maryland explains.

What Are the Health Consequences of a Retained Surgical Item?

A retained foreign object can remain undetected for months or even years. When symptoms eventually appear, patients are often told they are experiencing a normal recovery reaction or that their discomfort is unrelated to the surgery. The actual consequences can be serious and permanent.

• Chronic abdominal pain, pressure, and swelling

• Recurrent or antibiotic-resistant infection

• Abscess formation around the foreign object

• Bowel obstruction or perforation

• Fistula formation, an abnormal connection between organs

• Sepsis, which can be life-threatening

• Organ damage from pressure, erosion, or migration of the object 

Patients who develop these complications almost always require a second surgery to locate and remove the retained item, along with treatment for all secondary injuries caused by its presence. The physical, financial, and emotional toll can far exceed the original procedure.

Is a Retained Surgical Item Always Malpractice?

In Maryland and throughout the DMV, a retained surgical item is treated as a breach of the standard of care in virtually every case. The surgical team has an established, well-documented duty to account for every item used during a procedure. When that duty fails and a patient is harmed, the elements of a medical malpractice claim are almost always present:

• Duty of care. A physician-patient relationship existed.

• Breach. The surgical team failed to follow count protocols.

• Causation. The retained item caused injury, infection, or an additional procedure.

• Damages. The patient suffered measurable physical and financial harm. 

Because retained surgical items are classified as “never” events, hospitals and surgical centers are generally required to report them internally and may already have documented the failure. That documentation can become critical evidence in a legal claim.

Who Is Responsible for a Retained Surgical Item?

Liability in a retained foreign object case typically extends beyond the surgeon. Depending on how the failure occurred, responsible parties may include the scrub technician or surgical nurse who performed or confirmed the count, the operating room charge nurse, or the hospital or surgical center that established (or failed to enforce) counting protocols. Additionally, a surgical device manufacturer may be liable if a product lacked required radio-opaque markers that would make it visible on X-ray. 

How Is a Retained Surgical Item Claim Filed in Maryland?

Filing a retained surgical item claim follows the same process as any Maryland medical malpractice case. The statute of limitations in Maryland is generally five years from the date of injury or three years from the date of discovery of the harm, whichever comes first. Because patients may not discover a retained item until years after surgery, the discovery rule is especially important in these cases. Maryland also requires a certificate from a qualified medical expert before a malpractice lawsuit may proceed.

• The damages available in a successful claim typically include: 

• Cost of corrective surgery to remove the item

• Treatment for infections or other complications

• Lost wages during recovery

• Pain and suffering, and long-term consequences of the delayed diagnosis 

In cases where the retained item caused permanent harm, future medical expenses and diminished quality of life may also be recoverable, similar to what families face in catastrophic birth injury cases and other serious medical negligence matters.

If you suspect a retained surgical item may be the cause of unexplained symptoms after a procedure, getting prompt medical attention and consulting a DMV surgical error lawyer are the two most important steps you can take to protect both your health and your legal rights.

The DMV surgical error lawyers at Meyers, Rodbell & Rosenbaum are here to help. Our compassionate team will listen to your story, investigate your case, and work to secure the compensation you deserve.