Revised statement on the prevention of unintentionally retained surgical items after surgery

The following statement was revised by the American College of Surgeons (ACS) Committee on Perioperative Care and was reviewed and approved by the ACS Board of Regents at its June 2016 meeting.

The ACS recognizes patient safety as an issue of the highest priority and strongly urges individual hospitals and health care organizations to take all reasonable measures to prevent the unintended retention of surgical items in the surgical wound.

Surgical procedures take place within a system of perioperative care composed of surgeons, perioperative registered nurses, surgical technologists, and anesthesia professionals. These health care providers share a common ethical, legal, and moral responsibility to promote an optimal patient outcome.

Prevention of unintentionally retained surgical items after surgery requires good communication among perioperative personnel and the consistent application of reliable and standardized processes of care.

Therefore the ACS recommends the following guidelines that can be adapted to various practice settings, including traditional operating rooms (OR), ambulatory surgery centers, surgeons’ offices, and other areas where operative and invasive procedures are performed:

  • Recommendations to prevent the retention of sponges, sharps, instruments, and other designated miscellaneous items include:
    • Consistent application and adherence to standardized counting procedures
    • Performance of a methodical wound exploration before closure of the surgical site
    • Use of X ray-detectable items in the surgical wound
    • Maintenance of an optimal OR environment to allow focused performance of operative tasks
    • Use of X ray or other technology (such as radiofrequency detection and bar coding) as indicated to ensure that no unintended item remains in the operative field
    • Suspension of these measures may be necessary in certain life-threatening situations
  • Documentation should include, but not be limited to, results of surgical item counts, notification of the surgical team members, instruments or items intentionally left as packing, and actions taken if count discrepancies occur.
  • Surgical facilities must provide resources to ensure that necessary equipment and personnel are available to support these perioperative surgical safety measures.
  • Policies and procedures for the prevention of retained foreign bodies should be developed, reviewed periodically, revised as necessary, and available in the practice setting.
  • Disclosure of the event to patients and family members should follow the institution’s adverse event policy.

The ACS also endorses the National Quality Forum’s definition of “end of surgery” as the moment “…after all incisions or procedural access routes have been closed in their entirety, device(s) such as probes or instruments have been removed, and, if relevant, final surgical counts confirming accuracy of counts and resolving any discrepancies have concluded and the patient has been taken from the operating/procedure room,” where applicable.


The ACS offers this statement for consideration by surgeons, their hospitals, and health care organizations. This statement is provided as general guidance. It does not constitute a standard of care and is not intended to replace the professional judgment of the surgeon or health care administrator. This statement may be reviewed and modified as necessary to conform with the laws of the applicable jurisdiction, the circumstances of the individual hospital and health care organization, and requirements of other allied and health care organizations.


Cima RR, Kollengode A, Storsveen AS, et al. A multidisciplinary team approach to retained foreign objects. Jt Comm J Qual Patient Saf. 2009;35(3):123-132.

National Quality Forum. Serious Reportable Events in Healthcare–2011 Update: A Consensus Report. Washington, DC. Available at: Accessed August 15, 2016.

Recommended practices for prevention of retained surgical items. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:305-321.

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