Lost and found: trends in litigation and compensation related to retained surgical foreign bodies.

Introduction: Retained surgical foreign bodies are supplies and devices unintentionally left at the surgical site. They are generally considered never events, albeit even full compliance with procedures can only minimize the risk of their occurrence. As never events, affected patients often allege gross negligence, and hospitals are often forced to compensate for the damages. Despite the fact that the physical consequences of the retention are usually mild and temporary, and thus the compensation paid may be hypothesized to be correspondently low, clear data on the medico-legal outcomes of these claims-both extrajudicial and judicial-and the average compensation have not yet been described. Materials and methods: This paper presents a retrospective study on the related claims received between 1 January 2010 and 30 May 2024 by a large university hospital in Florence (Italy). The study aimed to deduce their incidence and mean costs, as well as the risk of medical malpractice claims leading to criminal complaints. Results: We identified 27 eligible cases, with a mean compensation of €20,695.49. During the same period, the claims unrelated to retained foreign bodies, used as controls, had a mean compensation of €67,542.26. When considering only non-fatal events, criminal lawsuits were present in 12% of the cases compared to 6% in the control group, which fell within the same compensation range. The majority of the cases (63%) were directly managed by the hospital, although this was a lower percentage compared to the control cases (76%). Discussion: In conclusion, even if the economic dimension of claims related to retained surgical foreign bodies is relatively contained, they are associated with a 2-fold risk of criminal lawsuits for doctors. In addition, patients are less confident about out-of-court settlements provided directly by hospital committees compared to judicial court trials. This indicates that patients perceive a retained surgical foreign body (RSFB) as a never event, which requires less justification compared to other wrongful medical care incidents. This perception is likely driven more by a breach of trust in doctors and hospitals than by the severity of consequences, which are typically mild or limited to temporary impairment.