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Significant value of autopsy for quality management in cardiac surgery
Ardawan J Rastan1, Jan F Gummert, Nicole Lachmann
1Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
Insights
Autopsies revealed significant discrepancies in cause of death and unrecognized complications in cardiac surgery patients. This highlights the autopsy
Area of Science:
- Cardiovascular Surgery
- Pathology
- Quality Management
Background:
- Advances in diagnostic imaging have led to questioning the value of autopsy.
- Autopsy plays a crucial role in verifying clinical diagnoses and identifying unexpected findings.
Purpose of the Study:
- To assess the impact of autopsy on early postoperative quality management in cardiac surgery.
- To evaluate the discrepancy rate between clinical diagnoses and autopsy findings.
Main Methods:
- Prospective analysis of clinical and postmortem data from 14,313 cardiac surgery patients (2000-2003).
- Autopsy was performed in 468 deceased patients (52.1%).
- Data analyzed included causes of death, complications, concomitant diseases, and surgery-associated findings.
Main Results:
- Discrepancies between clinical and autopsy diagnoses occurred in 23.1% of cases.
- Clinically unrecognized postoperative complications were identified in 77.8% of autopsies.
- Autopsy revealed significant premortem unrecognized surgery-associated pathologic findings in 18.2% of cases.
Conclusions:
- Autopsy remains essential for quality assessment in perioperative cardiac surgery.
- Significant discrepancies and clinically relevant findings underscore the value of autopsy.
- Autopsy data contribute to improving patient care and surgical quality management.
Objective:
With recent advances in diagnostic imaging, the value of autopsy has been called into question. The aim of our study was to assess the current impact of autopsy for early postoperative quality management in cardiac surgery.
Methods:
Between 2000 and 2003, a total of 14,313 patients underwent cardiac surgery at our center. Of these, 898 patients (6.3%) died, and autopsy was performed in 468 cases (52.1%). Data from clinical and postmortem examination were prospectively analyzed regarding causes of death, postoperative complications, concomitant diseases, and surgery-associated pathologic findings.
Results:
Mean age was 68.7 years. Mean survival was 13.9 postoperative days. On autopsy, causes of death were cardiac in 49.8% of cases (n = 233), respiratory in 8.3% (n = 39), cerebral in 6.4% (n = 30), abdominal in 4.7% (n = 22), multiorgan failure or sepsis in 14.9% (n = 70), pulmonary embolism in 6.6% (n = 31), procedure associated in 8.3% (n = 39), and others in 0.9% (n = 4). Discrepancies between clinical and postmortem determinations of cause of death were found in 108 cases (23.1%). These were acute myocardial infarction (n = 38), low cardiac output (n = 9), respiratory (n = 8), cerebral (n = 5), abdominal (n = 7), multiorgan failure or sepsis (n = 12), pulmonary embolism (n = 18), and procedure associated (11). Clinically unrecognized postoperative complications were found in 364 cases (77.8%). Unknown concomitant diseases were found in 464 cases (99.1%), with potential therapeutic relevance in 90 cases (19.2%). In 85 cases (18.2%), autopsy examination revealed 96 premortem unrecognized surgery-associated pathologic findings.
Conclusion:
A high overall discrepancy rate between premortem and autopsy diagnoses was recognized. Autopsy revealed clinically relevant information in a significant number of cases. Therefore autopsy remains essential for quality assessment in perioperative treatment.
