A rare case of iliopsoas abscess caused by a retained shrapnel from a blast injury

Iliopsoas abscesses (IPA) are uncommon, with an associated mortality rate of up to 20%. We describe the case of a 55-year-old man war veteran who presented with an unusual cause of IPA secondary to retained foreign body (FB). His initial trauma 30 years before was a result of a blast injury with shrapnel penetration suffered after inadvertently driving over a landmine as an ambulance driver in a conflict region. A CT scan was performed, revealing a 13 mmx8 mm radio-opaque FB within the right psoas at the level of the fifth lumbar vertebra with a surrounding collection. Subsequent open surgical exploration removed two gravel fragments. Given the knowledge of a traumatic blast injury with retained FB and repeated episodes of sepsis, surgical exploration is warranted. To our knowledge, this is the first case of recurrent IPA secondary to a retained FB from a historical trauma.

What do we Know about Contributing Factors for “Never Events” in Operating Rooms? A Machine Learning Analysis

BackgroundA Surgical “Never Event” (NE) is a preventable error. Various factors contribute to the occurrence of wrong site surgery and retained foreign item, but little is known about their quantified risk in relation to surgery's characteristics. Our study uses machine learning to reveal factors and quantify their risk to improve patient safety and quality of care.MethodsWe used data from 9,234 observations on safety standards and 101 Root-Cause Analysis from actual NEs, and utilized three Random Forest supervised machine learning models. Using a standard 10-cross validation technique, we evaluated the model's metrics, and, through Gini impurity we measured the impact of factors thereof to occurrence of the two types of NEs. ResultsWe identified 24 contributing factors in six surgical departments. Two had an impact of >900% in Urology, Orthopedics and General Surgery, six had an impact of 0–900% in Gynecology, Urology and Cardiology, and 17 had an impact of <0%. Factors' combination revealed 15-20 pairs with an increased probability in five departments: Gynecology:875–1900%; Urology: 1,900:2,600%; Cardiology:833–1,500%; Orthopedics:1,825–4,225%; and General Surgery:2,720–13,600%. Five factors affected the occurrence of wrong site surgery (-60.96–503.92%) and five of retained foreign body (-74.65–151.43%), three of them overlapping: two nurses (66.26–87.92%), Surgery length<1 hour (85.56–122.91%), Surgery length 1-2 hours (-60.96–85.56%).ConclusionsThe use of machine learning has enabled us to quantify the potential impact of risk factors for wrong site surgeries and retained foreign items, in relation to surgery's characteristics, which in turn suggests tailoring the safety standards accordingly. Trial registration number: MOH 032-2019

EP.TH.25Common General Surgical Never Events: An In-depth Analysis of Never Events data held by NHS England

Background There is little available data on common general surgical NE. Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the National Health Service (NHS) England. Methods We analyzed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE. Results There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355;44.54%) and Wrong Implant/Prosthesis and (n = 15;1.88%). We identified a total of 56 common general surgical themes - 25 each in Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants. Wrong skin condition surgery was the commonest wrong-site surgery (n = 117;27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum. Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were the most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%). Conclusion This study found 56 common general surgical Never Events. Increased awareness of these common themes of NE may ultimately help reduce their incidence.

REMOVAL OF RETAINED INTRATHORACIC FOREIGN BODY AFTER PENETRATING CHEST TRAUMA : NEW INSIGHT

Presence of foreign body in thoracic cavity is very uncommon. Most common causes for the presence of such foreign bodies are traumatic, accidental or iatrogenic. The management involves urgent identication and removal of the foreign body. Surgical extraction using thoracotomy or video-assisted thoracoscopic surgery(VATS) remains the primary management strategy. Herein, we report the case of successful removal of retained foreign body from lung after 4 years of penetrating chest trauma by thoracotomy under intraoperative ultrasonographic guidance.

SP7.1.5 Common General Surgical Never Events: Analysis of NHS England Never Events Data

Background There is little available data on common general surgical Never Events (NE). Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the NHS England. Methods We analysed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE. Results There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355; 44.54%), and Wrong Implant/ Prosthesis and (n = 15; 1.88%). We identified a total of 56 common general surgical themes - 25 each in the Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants. Wrong skin condition surgery was the commonest wrong-site surgery (n = 117; 27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum. Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%). Conclusion This study found 56 common general surgical NE. Increased awareness of these common themes of NE may help reduce their incidence.

Complications Associated With Nasopharyngeal COVID-19 Testing: An Analysis of the MAUDE Database and Literature Review

Background Nasopharyngeal swab testing, which has greatly increased in utilization due to the COVID-19 pandemic, is generally safe and well-tolerated, although it may be rarely associated with adverse events. Methods Publicly reported adverse events associated with nasopharyngeal COVID-19 testing within the Manufacturer and User Facility Device Experience (MAUDE) database and the published literature were queried. Results A total of 129 adverse events were reported, including 66 from the MAUDE database and 63 from literature review. The most common complications were swab fracture resulting in retained foreign body (47%), followed by epistaxis (17%), and headache (11%). Seven (12%) of the reported retained foreign body cases required removal under general anesthesia, while 1 (5%) of the epistaxis cases required surgical intervention. The most serious adverse event was meningitis following cerebrospinal fluid leak. Conclusions Patients and healthcare providers should be aware of the potential risks associated with testing, with attention to ensuring proper technique, and be prepared to recognize and manage adverse events.