Retained Surgical Item Incidence in the United States from 2016 to 2023: A Descriptive Study

Importance

Retained surgical items (RSI) are serious, preventable medical errors that continue to occur despite widespread implementation of safety protocols and technological interventions. Understanding RSI incidence can inform quality improvement aimed at prevention and patient safety.

Objective

To estimate the incidence of retained surgical items in the United States from 2016 to 2023 overall, annually, and stratified by state and surgery category.

Design

This was a longitudinal retrospective cohort study utilizing de-identified healthcare claims data from 2016 to 2023.

Setting

Data were from the Komodo Research Dataset, which aggregates medical and pharmacy claims from US commercial and government insurance sources.

Participants

198,619,904 surgeries between January 1, 2016, and December 31, 2023 where the patient had at least six months of prior continuous medical and pharmacy insurance enrollment. Surgeries were excluded if there was evidence of RSI before surgery or present on admission, surgery was performed in a US territory, or the patient was aged < 2 on the surgery date.

Exposure

Surgical procedures identified by administrative codes categorized as broad or narrow by the Agency for Healthcare Research and Quality.

Main Outcome(s) and Measure(s)

The primary outcome was the incidence proportion of RSIs, identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes up to 365 days after surgery. Incidence was estimated overall, annually, and stratified by state and surgical category. Data were analyzed from March 2025 to May 2025.

Results

The overall RSI incidence was 1.34 (95% CI: 1.32 to 1.36) per 10,000 surgeries, decreasing from 1.63 (95% CI: 1.58 to 1.70) in 2016 to 1.08 (95% CI: 1.04 to 1.12) in 2023. The 5 highest state-stratified RSI incidences were in the District of Columbia, Maine, Nebraska, Ohio, and West Virginia. Exploratory laparotomies and transplant surgeries had the highest surgery category-stratified RSI incidence.

Conclusion and Relevance

This large national claims-based study estimated RSI incidence and describes associated patterns in the US, confirming a persistent but declining annual incidence across the 8-year period. These findings highlight the ongoing need for targeted prevention strategies and system-wide efforts to reduce RSIs and improve surgical care.

Key Points