# Anterioposterior Views Coupled With Lateral Views Are the Best for the Intraoperative Radiographic Detection of Retained Surgical Sponges

## TL;DR

Combining anteroposterior and lateral X-rays improves detection of retained surgical sponges during spine surgery, reducing risks and legal issues.

## Contribution

This study demonstrates that combining AP and LAT radiographs provides higher accuracy in detecting retained sponges compared to using either view alone.

## Key findings

- LAT+AP radiographs showed the highest accuracy (80%), interobserver reliability (96%), and intraobserver reliability (96%).
- Sensitivity was highest with LAT+AP (87%), while LAT alone had the highest specificity (95%).
- Female sex, younger age, and higher BMI were associated with increased odds of correct detection.

## Abstract

Introduction: A retained sponge after spine surgery can cause serious medical complications and medicolegal problems. Intraoperative radiographs are commonly used to detect it. This study evaluated intraoperative radiographs under routine clinical conditions that most spine surgeons experience to detect retained sponges.

Methods: In this prospective randomized clinical trial, two patient groups undergoing open posterior lumbar surgery were studied. In one, a sponge was intentionally present; in the other, none was present. Standard intraoperative lateral (LAT) and anteroposterior (AP) radiographs were acquired before closing. Radiographs were analyzed for sensitivity, specificity, inter- and intraobserver reliability for three viewing conditions: one LAT radiograph versus one AP radiograph versus one LAT and one AP X-ray (LAT+AP).

Results: A total of 111 patients were included. Accuracy, interobserver reliability, and intraobserver reliability were best for LAT+AP (80%, 96%, and 96%, respectively). Sensitivity was best for LAT+AP (87%) and specificity was best for LAT (95%). Positive predictive value was best for LAT (94%); negative predictive value was best for LAT+AP (88%). The probability of being right is better for female sex (odds ratio 1.6), younger age (odds ratio 1.02), and higher BMI (odds ratio 1.06).

Conclusions: We recommend AP with LAT images rather than either an AP or a LAT image alone.