Is There Still a Role for Autopsy in Abdominal Surgery in 2008?

Introduction : Although autopsy has been shown to play an important role in certain surgical disciplines as cardiac surgery, few studies have been performed in digestive surgery. The purpose of the study is to determine if autopsy still has a role to play in abdominal surgery in 2008. Type of study : Retrospective study for the period 01.01.1996 to 31.12.2005. Methods : 8,586 patients underwent abdominal surgery during this period. The average age was 55.2 years and male/female sex ratio was 1.1. Surgery was elective in 82% and emergency in 18% of cases. The surgical approach was laparoscopic in 65% and open surgery in 35% of cases. In-hospital morbidity, reintervention and mortality rates were 9.5%, 0.9% and 2.4% respectively. Results : Among the 210 patients who died, thirty-three with generalized cancer or an extensive mesenteric infarct did not have an indication for autopsy; 74 of the remaining 177 patients, (42%) had an autopsy. The most frequent causes of death were respiratory complications, sepsis and cardiac complications. In 8% of cases, a surgical complication may have caused death. In 44.5% of cases, the results of autopsy showed either a missed major diagnosis that would have changed the patient's prognosis (Goldman class I : 18.9%), or a missed major diagnosis that would not have changed the patient's prognosis (Goldman class II : 25.6%). Conclusion : Despite technological progress, autopsy still has an important role to play in the assessment and improvement of the quality of surgical practice.