AnesthesiaWeb - Lit Reviews- Postoperative Death and Malpractice Suits: Is Autopsy Useful?

December 2000

Postoperative Death and Malpractice Suits: Is Autopsy Useful?
Juvin PJ, Teissiere F, Brion F, Desmonts J-M, Durigon M. Anesth Analg 2000;91:344-6

Commentary by Katherine Grichnik, M.D.

[see abstract below]

This is an interesting article about the usefulness of a postmortem examination, especially as related to determining the cause of a death. In the context of a malpractice suit, this has obvious implications for the anesthesiologist.

This brief communication sought to determine whether autopsies performed in the case of postoperative death with suspicion of malpractice help to identify the cause of death. The study design was a retrospective chart review that included all adult patients in three districts of France who had died after a surgical procedure between 1993 and 1998, and those who had an autopsy performed after a family had filed a malpractice suit. There were 15 patients identified. The study determined the primary diagnosis for the cause of death to be that made by the physician in charge and compared it to the autopsy diagnosis for the cause of death. Three physicians in different specialties reviewed the two diagnoses for each patient. Where they differed, the three physicians reviewed the data from the medical charts and the autopsies to confirm or refute the diagnosis.

The results are very enlightening to read and digest. Among 15 patients, 11 had primary diagnoses thought to be the cause of death by the primary care physician. Of these 11, only 3 of the primary diagnoses were confirmed as correct by the autopsy diagnosis! 7 of the primary diagnoses were corrected or refuted by autopsy data. One case was assigned a primary diagnosis but was unable to be confirmed by the pathological examination.

The remaining 4 cases were not assigned a primary diagnosis. Of these, autopsy identified the cause of death in 3 of the 4 cases. One case did not have a primary diagnosis and no diagnosis could be discerned pathologically.

How interesting that most of the cases either did not carry a primary diagnosis (there were no plausible reasons for the patient's demise) or had a primary diagnosis refuted by autopsy data. It would seem that we are not as good at diagnosing a reason for perioperative death as we, perhaps, think we should be.

It would seem prudent to pursue postmortem examination whenever possible. Some of the autopsy diagnoses, such as esophageal cancer or congenital coronary artery abnormality, may aid the clinician in defense of malpractice suits. We also learn from autopsy diagnoses, especially to look for causes of death that have not been previously suspected. Of course, an autopsy diagnosis may refute our primary diagnoses in support of a claim that medical care could have been more accurate. However, this is the risk that we all take in pursuing knowledge so that we can care for future patients with even greater skill.

In summary, this article is informative, interesting and challenges us to truly find out why a perioperative death has occurred.