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The autopsy: still important in cardiac surgery
K J Zehr1, J R Liddicoat, J D Salazar
1Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
The Annals of Thoracic Surgery
|August 1, 1997
Summary
Autopsies confirm the cause of death in most cardiac surgery patients, often revealing critical information missed during clinical assessment. This highlights the autopsy's vital role in improving cardiac surgical care quality.
Area of Science:
- Medical Science
- Pathology
- Cardiovascular Surgery
Background:
- Examined the diagnostic accuracy of autopsies in determining the cause of death for cardiac surgery patients.
- Assessed the concordance between presumptive clinical diagnoses and autopsy findings.
Purpose of the Study:
- To evaluate the role of autopsy in confirming or refuting the presumed cause of death in patients who underwent cardiac surgery.
- To determine the impact of autopsy findings on clinical understanding and potential therapeutic interventions.
Main Methods:
- Compared autopsy reports with prospectively dictated mortality conference notes.
- Analyzed data from 13,029 adult cardiac surgery patients with 600 hospital deaths between 1985 and 1995.
- Included 147 autopsies (24.5% of deaths) in the analysis.
Main Results:
- Autopsies confirmed the clinical presumptive cause of death in 52% of cases and disputed it in 9.5%.
- Autopsies provided a definitive diagnosis in 13.6% of cases where clinical diagnosis was absent.
- Clinically unrecognized information, potentially altering therapy, was found in 39% of autopsies.
- Common causes of death included cardiac (27%), unknown (25%), sepsis (14%), and stroke (8.8%).
Conclusions:
- Autopsy confirms or reveals the cause of death in nearly 75% of cardiac surgical fatalities.
- Autopsy findings significantly differed from premortem clinical impressions in over 20% of cases.
- The autopsy remains an essential tool for quality assurance in cardiac surgical care.