Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Anesthesiology. 2011 Oct;115(4):713-7. doi: 10.1097/ALN.0b013e31822ea220.
The rate of autopsy in hospital deaths has declined from more than 50% to 2.4% over the past 50 yr. To understand the role of autopsies in anesthesia malpractice claims, we examined 980 closed claims for deaths that occurred in 1990 or later in the American Society of Anesthesiologists Closed Claims Project Database.
Deaths with autopsy were compared with deaths without autopsy. Deaths with autopsy were evaluated to answer the following four questions: Did autopsy findings establish a cause of death? Did autopsy provide new information? Did autopsy identify a significant nonanesthetic contribution to death? Did autopsy help or hurt the defense of the anesthesiologist? Reliability was assessed by κ scores. Differences between groups were compared with chi-square analysis and Kolmogorov-Smirnov test with P < 0.05 for statistical significance.
Autopsies were performed in 551 (56%) of 980 claims for death. Evaluable autopsy information was available in 288 (52%) of 551 claims with autopsy. Patients in these 288 claims were younger and healthier than those in claims for death without autopsy (P < 0.01). Autopsy provided pathologic diagnoses and an unequivocal cause of death in 21% of these 288 claims (κ= 0.71). An unexpected pathologic diagnosis was found in 50% of claims with evaluable autopsy information (κ = 0.59). Autopsy identified a significant nonanesthetic contribution in 61% (κ = 0.64) of these 288 claims. Autopsy helped in the defense of the anesthesiologist in 55% of claims and harmed the defense in 27% (κ = 0.58) of claims with evaluable autopsy information.
Autopsy findings were more often helpful than harmful in the medicolegal defense of anesthesiologists. Autopsy identified a significant nonanesthetic contribution to death in two thirds of claims with evaluable autopsy information.
在过去的 50 年中，医院死亡病例的尸检率从超过 50%下降到 2.4%。为了了解尸检在麻醉医疗事故索赔中的作用，我们检查了美国麻醉师协会（ASA）尸检索赔数据库中 1990 年或之后发生的 980 例已结案的死亡索赔。
对有尸检和无尸检的死亡病例进行比较。对有尸检的死亡病例进行评估，以回答以下四个问题：尸检结果是否确定了死因？尸检是否提供了新的信息？尸检是否确定了对死亡有重要影响的非麻醉因素？尸检是否有助于或损害麻醉师的辩护？采用κ评分评估可靠性。用卡方分析和 Kolmogorov-Smirnov 检验比较组间差异，以 P<0.05 为有统计学意义。
980 例死亡索赔中有 551 例（56%）进行了尸检。在有尸检的 551 例索赔中，有 288 例（52%）可评估尸检信息。这些 288 例索赔的患者比无尸检的索赔患者年龄更小、更健康（P<0.01）。尸检在这些 288 例索赔中，21%（κ=0.71）提供了病理诊断和明确的死因。在有可评估尸检信息的索赔中，50%（κ=0.59）发现了意外的病理诊断。尸检在这些 288 例索赔中，61%（κ=0.64）确定了对死亡有重要影响的非麻醉因素。尸检在 55%（κ=0.58）的索赔中有助于麻醉师的辩护，在 27%（κ=0.58）的索赔中损害了辩护。
尸检结果在麻醉医师的医疗法律辩护中通常是有益的，而不是有害的。尸检在有可评估尸检信息的索赔中，三分之二确定了对死亡有重要影响的非麻醉因素。
