Retained foreign objects after surgical procedures are considered a never event. The traditional method of preventing such incidents is the count—manually tracking and reconciling the number of sponges and instruments used during the procedure. Prior studies have shown counting to be inaccurate and an inadequate method of preventing retained foreign objects. This study analyzed the costs associated with manual counts at an academic medical center and found that this resulted in a total annual cost of more than $200,000, most of which was attributable to unavailability of the operating room. At this hospital, there were 212 incorrect counts (potential retained foreign objects) over a 9-month period. Given that manual counting is questionably effective at best, the fact that it is associated with worsened efficiency and increased costs may prompt use of newer methods to prevent retained foreign objects.