Use of autopsy in general surgery: a comparison of practice and opinion

To examine current practice regarding autopsy requests and assess consultant opinion regarding the role of autopsy in a general surgical department.

One hundred deaths that occurred in a teaching hospital general surgical department, over a 2-year period, were randomly selected. After review of the hospital notes, a brief summary of each admission was distributed to all 13 consultant general surgeons in the department. Surgeons were asked to comment whether each case should have been discussed with the coroner, whether a coroner's autopsy should have been carried out, whether a hospital post-mortem examination should have been carried out and whether it would be appropriate to complete a death certificate without a post-mortem examination. Surgeon responses were compared with actual outcomes, and both were analysed for predictors of variation in practice.

The majority of patients were elderly (median age 79 years, 49% >80 years), were admitted acutely (92%) and did not undergo an operation (73%). Thirty-three patients died of cardiac or respiratory causes. Patients who had undergone a recent operation were more likely to be referred to the coroner (P < 0.001) and more likely to undergo coroner's autopsy (P = 0.011). Older patients and those admitted from a rest home were less likely to be referred to the coroner (P < 0.001 and 0.02, respectively) or undergo coroner's autopsy (P = 0.002 and 0.011, respectively). The survey predicted more referrals to the coroner (44 vs 30, P = 0.001) and more hospital autopsies (21 vs 2, P < 0.001) and that the treating doctor would complete the certificate of death less often than actually happened (79 vs 91, P = 0.004). The survey suggested that surgeons were more likely to complete the certificate of death in patients with active malignancy (P = 0.01), but this was not observed in practice.

General surgeons consider autopsy to be necessary more often than that is taking place in practice in our institution. The continued decline in autopsy rates may compromise the safety and quality of the service provided by general surgeons and result in a gap in the education of surgeons and trainees.