Post-surgical Autopsy Findings: Insights Into Forensic Evaluation and Surgical Complications

This systematic review examined the role of autopsy in identifying fatal surgical complications and diagnostic discrepancies across diverse contexts over the past decade. A structured search of PubMed, Scopus, Web of Science, and reference lists identified 252 records, from which 11 studies were included after rigorous screening. The evidence base encompassed retrospective cohorts, single-case reports, experimental animal studies, and archaeological analyses, reflecting heterogeneous designs, populations, and surgical contexts. Major discrepancies between clinical diagnoses and autopsy findings were observed in up to 47% of cases, most frequently involving hemorrhage, sepsis, pulmonary embolism, and anastomotic leaks. While autopsy consistently clarified causes of death and provided critical insights for patient safety and medicolegal accountability, the overall certainty of evidence was moderate to low due to study heterogeneity, publication bias, and variable reporting quality. These findings underscore the persistent gap between perioperative expectations and actual outcomes and highlight the irreplaceable role of autopsy in quality improvement, risk reduction, and forensic practice. The next step in research should focus on standardized guidelines, strong multicentric partnerships, and follow-ups to more effectively incorporate autopsy data on surgical safety planning and training. The synthesis proves that autopsy is a valuable, underused instrument of enhancing care, transparency, and evidence-based practice in contemporary healthcare systems.