title: Significant value of autopsy for quality management in cardiac surgery.
abstract: OBJECTIVE
  With recent advances in diagnostic imaging, the value of autopsy has been called into question. The aim of our study was to assess the current impact of autopsy for early postoperative quality management in cardiac surgery.
  
  
  METHODS
  Between 2000 and 2003, a total of 14,313 patients underwent cardiac surgery at our center. Of these, 898 patients (6.3%) died, and autopsy was performed in 468 cases (52.1%). Data from clinical and postmortem examination were prospectively analyzed regarding causes of death, postoperative complications, concomitant diseases, and surgery-associated pathologic findings.
  
  
  RESULTS
  Mean age was 68.7 years. Mean survival was 13.9 postoperative days. On autopsy, causes of death were cardiac in 49.8% of cases (n = 233), respiratory in 8.3% (n = 39), cerebral in 6.4% (n = 30), abdominal in 4.7% (n = 22), multiorgan failure or sepsis in 14.9% (n = 70), pulmonary embolism in 6.6% (n = 31), procedure associated in 8.3% (n = 39), and others in 0.9% (n = 4). Discrepancies between clinical and postmortem determinations of cause of death were found in 108 cases (23.1%). These were acute myocardial infarction (n = 38), low cardiac output (n = 9), respiratory (n = 8), cerebral (n = 5), abdominal (n = 7), multiorgan failure or sepsis (n = 12), pulmonary embolism (n = 18), and procedure associated (11). Clinically unrecognized postoperative complications were found in 364 cases (77.8%). Unknown concomitant diseases were found in 464 cases (99.1%), with potential therapeutic relevance in 90 cases (19.2%). In 85 cases (18.2%), autopsy examination revealed 96 premortem unrecognized surgery-associated pathologic findings.
  
  
  CONCLUSIONS
  A high overall discrepancy rate between premortem and autopsy diagnoses was recognized. Autopsy revealed clinically relevant information in a significant number of cases. Therefore autopsy remains essential for quality assessment in perioperative treatment.
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Ardawan J
authors.initials: AJ
authors.lastname: Rastan
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
authors.forename: Nicole
authors.initials: N
authors.lastname: Lachmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Dierck V
authors.initials: DV
authors.lastname: Schmitt
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Nico
authors.initials: N
authors.lastname: Doll
authors.forename: Paul
authors.initials: P
authors.lastname: Caffier
authors.forename: Markus M
authors.initials: MM
authors.lastname: Richter
authors.forename: Christian
authors.initials: C
authors.lastname: Wittekind
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D001344:Autopsy; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000592:standards*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D017749:Total Quality Management