Postoperative death should be followed by autopsy -: an analysis of the autopsy findings of the years 1990 and 1991 in a Heart Surgery Center

Background: In this retrospective analysis of all autopsies performed in 1990 and 1991 on cardiac surgery patients who died before discharge from our university hospital, we Intended to test the use of postmortem examination among cardiac surgery patients. Methods: Perioperative! data of all patients who underwent: autopsy because of postoperative death during this time period were collected using a retrospective analysis of hospital and autopsy records. Results: In 1990 and 1991 a total of 2407 patients underwent cardiac surgery with extracorporeal circulation at our institution. The in-hospital mortality was 2.9% (n=36) in 1990 and 3.3% (n=40) in 1991. For most of all patients who died during the postoperative course, we found a highly symptomatic cardiac disease and significant co-morbid conditions. The autopsy rate was 46.1 % (35/76 patients). Cardiac failure with shock symptoms was the leading course of death (68.6%). In 22.9% of these patients (n=8) the autopsy provided information which had not been clinically recognized (e.g. myocardial infarction, thrombosis of bypass grafts, pneumonia) but might have altered the postoperative therapy if it: had been. Conclusion: Despite the well-known trend of decreasing autopsy rates in the western world we believe that the postmortem examination is a most valuable diagnostic tool in the setting of a university cardiac surgery unit. Our results confirm the importance of autopsies for all patients who die after the operation, because a significant part of autopsies reveals major discrepancies between clinical and postmortem diagnoses. In an effort to maintain a high quality of treatment and education the autopsy rate of a hospital is of utmost interest.