Autopsy analysis in surgical patients: A basis for clinical audit

Barendregt, W.B.; Boer, H.H.M. de; Kubat, K

doi:10.1002/bjs.1800791218

Cited by 33 publications

(34 citation statements)

References 18 publications

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“…3,4 In spite of advances in medical technology, there is still a high discrepancy rate between the clinical and postmortem diagnoses of deceased patients. 5,6 …”

Section: Introductionmentioning

confidence: 99%

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A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department

O’Connor

2002

Academic Emergency Medicine

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Objectives: In spite of advances in medical technology, there remains a high discrepancy rate between the antemortem clinical diagnosis and postmortem examination diagnosis for patients who die in hospitals. The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancy between them. Methods: The study was a retrospective chart review of patients who died in the ED of a tertiary referral teaching hospital and a comparison of the antemortem diagnosis with the autopsy diagnosis. Any missed diagnosis was classified, according to the Goldman criteria, into major and minor missed diagnoses. Results: A total of 59 patients were eligible for inclusion in the study. There was complete agreement between the antemortem diagnosis and the autopsy result in 51% of cases. The incidence of major missed diagnoses-where if the diagnosis had been known before the patient died, treatment may have been altered or survival may have been prolonged-was 7%. Conclusions: There is a significant discrepancy rate between the antemortem diagnosis and the autopsy diagnosis. However, in this study, serious missed diagnoses in which outcome may have been significantly altered are unusual among those who die in the ED of a tertiary referral hospital. Key words: autopsy; postmortem examination; emergency medicine; diagnosis. ACADEMIC EMERGENCY MEDICINE 2002; 9:957-959. Postmortem examinations, although suffering a decline in usage during the past few decades, remain a valuable contributor to our medical education and toward the understanding of medicine's limitations.1,2 Moreover, they serve as important quality assurance indicators of clinical acumen and diagnostic tools, and as a measure of the efficacy and appropriateness of any therapy administered. 3,4 In spite of advances in medical technology, there is still a high discrepancy rate between the clinical and postmortem diagnoses of deceased patients. 5,6

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“…3,4 In spite of advances in medical technology, there is still a high discrepancy rate between the clinical and postmortem diagnoses of deceased patients. 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 In spite of advances in medical technology, there is still a high discrepancy rate between the clinical and postmortem diagnoses of deceased patients. 5,6 The aim of this study was to compare the clinical and postmortem examination diagnoses of patients who died in the emergency department (ED) of a tertiary hospital, and to analyze any discrepancies.…”

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confidence: 99%

A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department

O’Connor

2002

Academic Emergency Medicine

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“…Anastomotic leakage was one of the most important factors, causing postoperative death in 17%. This is also seen in other studies, where anastomotic leakage that led to death varies from 14 to 18% [7, 13, 14]. Despite this accordance with the literature, anastomotic leakage is something that has to be evaluated carefully.…”

Section: Discussionmentioning

confidence: 60%

Mortality after Colon Surgery: The Value of a Mortality Registration System

Maartense¹,

Peeters²,

Spaander³

et al. 2003

Dig Surg

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Background/Aims: Postoperative mortality after colon surgery is relatively infrequent. In order to evaluate the quality of colon surgery, post-mortem evaluation is useful. This study was performed to determine the value of a mortality register used at the Department of Surgery of the Red Cross Hospital. Methods: From 1991 to 2000, 882 colon resections were performed for both malignant and benign disorders, including elective and emergency surgery. Permission for autopsy was asked routinely. All cases were reviewed and categorized in a multidisciplinary meeting. Any discrepancy between the clinical and post-mortem diagnosis was determined by a pathologist. Results: The mortality rate of colon surgery was 8.0% (n = 71), 23% for emergency surgery and 6% for elective surgery (p < 0.001). For patients under 70 years of age the mortality rate was 4.3%, for patients over 70 years of age 11.2% (p < 0.001). Autopsy was performed in 62% (n = 44) of the patients. Discrepancy between clinical and post-mortem findings was documented in 14%. Conclusion: Postoperative mortality after colon surgery is influenced by the timing of surgery (elective or emergency procedure) and the age of the patient. A discrepancy of 14% between clinical cause of death and post-mortem cause of death justifies the need for obtaining autopsy in this type of surgery.

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“…Knowing the cause of death is important for general knowledge of diseases and their complications to improve the quality of care and to monitor new investigative techniques and treatment modalities [17]. In addition, autopsy results help the parents grieve [1,4,8,9,11,17]. However, we are aware that not all these benefits are present in postmortem biopsies.…”

Section: Discussionmentioning

confidence: 99%

“…Autopsies are not merely necessary to obtain or confirm the cause of death, but can also be instrumental for translational research to improve our understanding of diseases. As a result, we may create new therapeutic strategies and/or evaluate the effects of new treatment strategies [1,8,9]. Due to the decline in permission for autopsies, less translational research based on human tissue samples investigating the pathogenesis of diseases can be performed.…”

Section: Introductionmentioning

confidence: 99%

Postmortem Biopsy to Obtain Lung Tissue in Congenital Diaphragmatic Hernia

et al. 2013

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Background: The accrual of human tissues from autopsies for diagnostic and translational research has decreased significantly over the last decades. Objectives: The objective of this study was to evaluate our experience with lung biopsy through a minithoracotomy as an alternative for obtaining postmortem tissue when full autopsy is refused in congenital diaphragmatic hernia (CDH) patients. Methods: Within 2 h of death we routinely asked parents for permission to perform an autopsy. Starting in 2001, parents who refused autopsy were asked permission for a postmortem lung biopsy. Pathology autopsy and biopsy reports were compared to clinical records. Results: Between 2001 and 2009, 46 patients died from CDH. Permission for autopsy was granted in 5 patients (11%). Of the remaining 41 patients, the parents of 15 (33%) agreed to postmortem lung biopsy. In all cases, additional findings were reported from the autopsy or biopsy, without changing the originally reported cause of death. In 1 case, we isolated fibroblasts from the lung biopsy using standardized cell culture techniques. Parents were able to take their child home with a minimal delay following biopsy. Conclusions: Parents refusing a full autopsy frequently agree to postmortem organ biopsy. This approach should therefore be considered as a valuable alternative, when permission for full autopsy is declined, for obtaining human tissues for both diagnostic and research purposes and is potentially applicable to other anomalies.

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Autopsy analysis in surgical patients: A basis for clinical audit

Cited by 33 publications

References 18 publications

A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department

A Comparison of the Antemortem Clinical Diagnosis and Autopsy Findings for Patients Who Die in the Emergency Department

Mortality after Colon Surgery: The Value of a Mortality Registration System

Postmortem Biopsy to Obtain Lung Tissue in Congenital Diaphragmatic Hernia

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