Foreign body entrapment during thoracic surgery-time for closed loop communication.

OBJECTIVES: During general thoracic surgery procedures, devices are often placed in the airway and oesophagus. This creates an opportunity for foreign body entrapment (FBE) during pulmonary and foregut surgery. Like retained foreign bodies (RFB), FBE is an entirely preventable event. Unlike RFB, there is minimal literature on FBE, thus little is known about its occurrence, risk factors, and prevention.

METHODS: A survey was distributed to 215 surgeons of the General Thoracic Surgical Club. The survey included questions about socio-demographics, procedural volume, occurrence of FBE and factors leading to FBE.

RESULTS: There were 110 responses (51%, 110/215). The majority of respondents worked in academic hospitals (75%, 82/110), in urban environments (63%, 69/110), and were male (85%, 94/110). One hundred and four respondents performed pulmonary resections and 92 performed foregut surgeries. In the pulmonary group, 40% (42/104) reported FBE with 67% (23/42) in open procedures. In the foregut group 38% (35/92) reported FBE with 69% (24/35) in open procedures. With both groups combined, 54.5% (60/110) of respondents reported FBE at least once and 29% (24/110) reported more than one FBE in their career. The most frequently reported contributing factor was communication errors between the surgical and anaesthesia teams.

CONCLUSIONS: FBE during general thoracic procedures occurs in both minimally invasive and open pulmonary and foregut procedures. The greatest risk factor is communication error. Specific routine closed loop communication with the anaesthesia team prior to stapling/suturing the airway or oesophagus would minimize the risk of FBE.