Orthopedic Surgeon Leaves Equipment Inside Patient’s Wound Causing Infection

This case involves an 80-year-old man who underwent a right hip resection arthroplasty including removal of femoral head and neck. Several months later, he underwent a right hip arthrotomy and hip abscess drainage at the same hospital. During this surgery, a wound VAC was applied to his hip and packed with a wound VAC sponge. The patient was sent home with home care. The patient’s hip wound never fully healed, and the patient was re-admitted to the emergency room a few months later for additional wound draining. X-rays were ordered and reviewed, but the patient was sent home every time. The patient eventually sought treatment at a different medical center the following year where it was discovered that a VAC sponge had been left deep inside the patient’s hip wound.

Question(s) For Expert Witness

1. How should the treating surgeon communicate with the home health staff about the sponge packed in the patient's hip?

2. What are the policies/procedures in place to ensure that a wound VAC sponge is not left in the patient once it is no longer needed?

3. At what point should the sponge have been discovered and removed?

4. Would any imaging have helped?

Expert Witness Response E-161642

Luckily, resection arthroplasties are rare, but I have treated 2 patients in the last year with a very similar initial presentation. Home health must be made aware of the sponge count and type of sponge used in the wound to avoid such a never event in any deep wound. This should be arranged before discharge from the hospital, and we typically speak with the local supervisor of the home health company to ensure this issue does not occur. Like any device or dressing material that enters into a patient, particularly with a deep wound, it is vital to keep an accurate record of the number of materials used and the location of any deep packing material. This record should be updated at each dressing change so that as the wound begins to close, dressings are not lost. I also like to leave a tail visible at the surface for any wound vac sponge so it is visible at the time the dressing is changed. The sponge is difficult to see on x-ray, but generally, persistent drainage from the wound should prompt the surgeon to look for a cause of potential infection by ordering MRI (which would be more likely to show foreign body) or considering surgical exploration and washout, particularly with persistent drainage over a 4-6 week period. It should never take a year and a half to make that diagnosis. The retained sponge would act as a nidus for an infection that likely would not clear with antibiotics.