PROSPECTIVE-STUDY OF THE VALUE OF NECROPSY EXAMINATION IN EARLY DEATHAFTER CARDIAC-SURGERY

Objective-To necropsy examination in patients dying soon after cardiac surgery, particularly the proportion of clinical questions answered b y the necropsy, the frequency of major unexpected findings, and the li mitations of the procedure. Design-A three year prospective study of n ecropsy examinations in adult patients dying before discharge or withi n 30 days of cardiac surgery performed under cardiopulmonary bypass in one hospital. Setting-Tertiary referral centre. Results-123 of 2781 p atients (4.4%) died in the early postoperative period, and necropsy ex amination was performed in 108 of these (88%). The mortality after eme rgency procedures (18%) was much higher than after routine operations (2.6%). The main causes of death were cardiac failure (52%), haemorrha ge (14%), cerebral disease (6%), and pulmonary emboli (5%). The necrop sy changed the stated cause of death in 16 patients (15%), and answere d clinical questions in 24 of 38 patients. In 15 patients necropsy exa mination did not provide a full explanation of death. Most of these pa tients died of cardiac failure soon after surgery or were sudden unexp ected deaths. Conclusions-Necropsy examination in patients dying early after cardiac surgery is valuable as it answers the majority of clini cal questions, and shows unexpected findings in a significant:proporti on of cases.