Significant value of autopsy for quality management in cardiac surgery

Rastan, Ardawan; Gummert, Jan; Lachmann, Nicole; Walther, Thomas; Schmitt, D; Falk, Volkmar; Doll, N.; Caffier, P.; Richter, Markus M.; Wittekind, Christian; Mohr, Friedrich W.

doi:10.1016/j.jtcvs.2004.12.018

Cited by 34 publications

(27 citation statements)

References 22 publications

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“…The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses (Tables 1 and 2). 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84 Of the 16 RCTs identified,1...…”

Section: Resultsmentioning

confidence: 99%

“…We noted that fatal PE after cardiac surgery still occurred within the last decade despite advances in cardiac surgical care, including routine use of low‐dose aspirin post‐CABG 23, 26, 71, 73, 77. Fatal PE accounted for approximately 11% to 20% of all unexplained deaths after cardiac surgery, with at least 50% not diagnosed before death 57, 58. Median incidence of fatal PE (0.3%) reported in this review was consistent with the data from these 2 postmortem reports if the overall mortality after cardiac surgery was approximately 3%, and this may, in part, explain why omission of early VTE prophylaxis is associated with an increased mortality in the critically ill 92.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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BackgroundOptimal thromboprophylaxis after cardiac surgery is uncertain. This systematic review aimed to define the incidence and risk factors for deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE), and assess whether venous thromboembolism (VTE) prophylaxis was effective in reducing VTE without complications after cardiac surgery.Methods and ResultsTwo reviewers independently searched and assessed the quality and outcomes of randomized, controlled trials (RCTs) and observational studies on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane controlled trial register (1966 to December 2014). Sixty‐eight studies provided data on VTE outcomes or complications related to thromboprophylaxis after cardiac surgery. The majority of the studies were observational studies (n=49), 16 studies were RCTs, and 3 were meta‐analyses. VTE prophylaxis was associated with a reduced risk of PE (relative risk [RR], 0.45; 95% confidence interval [CI], 0.28–0.72; P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28–0.71; P=0.0006) compared to the control without significant heterogeneity. Median incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were 3.2% (0.6–8.1), 0.6% (0.3–2.9), and 0.3% (0.08–1.7), respectively. Previous history of VTE, obesity, left or right ventricular failure, and prolonged bed rest, mechanical ventilation, or use of a central venous catheter were common risk factors for VTE. Bleeding or cardiac tamponade requiring reoperation owing to pharmacological VTE prophylaxis alone, without systemic anticoagulation, was not observed.ConclusionsUnless proven otherwise by adequately powered RCTs, initiating pharmacological VTE prophylaxis as soon as possible after cardiac surgery for patients who have no active bleeding is highly recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Bham

Pavey

2015

JAHA

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“…Insbesondere wird kritisiert, dass mit diesem Rückgang ein wichtiges Element der Qualitätssicherung wegfallen würde [5][6][7][8]. Zahlreiche Ursachen sind für den "Niedergang" der Zahl der Obduktionen angeführt worden, u. a. niedrige Zustim mungsraten der Angehörigen (.…”

Section: Hintergrundunclassified

Vorschläge zur standardisierten Abfassung von Obduktionsberichten

2014

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“…Five centres have reported their findings [9][10][11][12][13] and these are summarised in table 2. Although the pattern of surgery and the post mortem rate differed, there were some consistent findings.…”

Section: What Has Been Learnt From Autopsies Performed On Patients Dymentioning

confidence: 99%

“…In the same context 15% of deaths after cardiac surgery in Leipzig between 2000 and 2003 were ascribed to multi-organ failure. 13 The use of histology had declined from 77% to 48%, even though it is recognised that lack of histology detracts from the value of perioperative autopsy reports. 2 16 Recent, more focused autopsy studies have examined changes in specific organs in patients dying after cardiac surgery.…”

Section: What Has Been Learnt From Autopsies Performed On Patients Dymentioning

confidence: 99%

Post mortem examinations after cardiac surgery

Hickling

Pontefract

Gallagher³

et al. 2007

Heart

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A t present in England and Wales just over 20% of all deaths are followed by a post mortem examination, almost all on the instructions of a coroner. In contrast, in Scotland and Northern Ireland the rates are below 10%. In a wider context overall post mortem rates in the provinces of Canada vary between 5-9% and are probably much lower in France and Germany. The reasons for this variation are unknown. Remarkably there has been no national audit of the indications for, or value of, autopsy examination. In this review we consider: c why autopsies should be performed after cardiac surgery c who should perform these autopsies and how they should be reported c what has been learnt from post mortem examinations performed on patients dying after cardiac surgery c what the role of these autopsies is in the future. POST MORTEM EXAMINATION AFTER SURGERY cPathologists frequently refer to the many published studies which have shown that important new information is detected in autopsies performed in patients dying in hospital.1 At least two have shown that the rate of unexpected findings has not altered significantly over several decades. Methods have been developed to categorise the degree of concordance between pre-mortem clinical diagnoses and post mortem findings.2 A recent meta-analysis identified discrepancies in 10-20.6% of post mortem examinations where the patient would potentially have survived if the correct diagnosis had been known in life. 4 Although most of these studies have included patients dying after surgery, there have been few that specifically studied the value of post mortem examination after surgery. A retrospective study from Connecticut studied the clinical records and post mortem reports of 150 patients who died in a surgical intensive care unit. There was full agreement in only 58% of cases. The longer the patient was in the unit the greater the chance was of an unexpected finding. Infection was the most common undiagnosed condition, especially in patients who had received a transplant. 6 Impressed by these findings, we made a similar audit of 92 patients dying in our hospital after surgery in 2002 who had an autopsy. We found full agreement in 65%, a major disagreement in 20% and less important discrepancies in 15% of cases. Infection, pulmonary thromboembolism and ischaemic heart disease were the most important conditions diagnosed at post mortem examination. Important discrepancies were identified in 33% of orthopaedic procedures, 31% of neurosurgical, 27% of general surgical operations, but only 5.7% of cardiac operations.

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Significant value of autopsy for quality management in cardiac surgery

Abstract: 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.

Cited by 34 publications

References 22 publications

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta‐Analysis

Vorschläge zur standardisierten Abfassung von Obduktionsberichten

Post mortem examinations after cardiac surgery

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