Li Hange, Wang Yu, Wang Zihan, Zhao Dachun, Guo Xidong, Zhang Hanbo, He Yanrong, Zeng Huatang, Zhu Jiming
Vanke School of Public Health, Tsinghua University, Beijing, China.
Institute for Healthy China, Tsinghua University, Beijing, China.
BMJ Open. 2025 Jan 7;15(1):e090430. doi: 10.1136/bmjopen-2024-090430.
This study investigated the autopsy rate of hospital deaths in Shenzhen megacity and identified factors that may impact the decision to perform an autopsy in hospital deaths.
This is a population-based retrospective cohort study.
Shenzhen is a megacity in China with a population of more than 17 million and a total of 151 hospitals. The official dataset of the inpatient medical record home page was used. Demographic, clinical and hospital information was extracted.
All the 35 272 inpatient deaths between 2016 and 2022 with known autopsy status were included to calculate the overall autopsy rate. Among them, a total of 34 577 cases with complete data, classified hospital and Chinese nationality, were included for further multivariable rare events logistic regression and Poisson pseudo maximum likelihood regression.
Whether the inpatient death was autopsied or not.
The autopsy procedure was performed in 0.9% (319/35 272) of hospital deaths. The autopsy decision was significantly and positively associated with being married (OR= 1.60, 95% CI: 1.16 to 2.21), self-paying (OR=1.56, 95% CI: 1.07 to 2.26), death due to external causes of injury and poisoning (OR=1.69, 95% CI: 1.02 to 2.81) and pregnancy (OR=13.58, 95% CI: 4.94 to 37.36), but negatively associated with age (OR=0.97, 95% CI: 0.96 to 0.98), emergency admission (OR=0.66, 95% CI: 0.49 to 0.88), referral (OR=0.47, 95% CI: 0.25 to 0.88), neoplasms (OR=0.35, 95% CI: 0.22 to 0.56), respiratory diseases (OR=0.49, 95% CI: 0.26 to 0.95) and for-profit hospitals (OR=0.45, 95% CI: 0.23 to 0.91). There were no statistically significant differences in autopsy rates between large teaching hospitals and other hospitals.
The autopsy rate of hospital deaths was extremely low, largely due to healthcare providers. Even large teaching hospitals do not request more autopsies compared with other hospitals, after controlling for the patient characteristics. More efforts are urged to encourage hospitals and healthcare providers to proactively request autopsies, helping to revive this important procedure.
本研究调查了深圳市大型城市医院死亡病例的尸检率，并确定了可能影响医院死亡病例尸检决策的因素。
这是一项基于人群的回顾性队列研究。
深圳是中国的一个大型城市，人口超过1700万，共有151家医院。使用了住院病历主页的官方数据集。提取了人口统计学、临床和医院信息。
纳入了2016年至2022年间所有已知尸检状态的35272例住院死亡病例，以计算总体尸检率。其中，共有34577例数据完整、医院分类明确且为中国国籍的病例纳入进一步的多变量罕见事件逻辑回归和泊松伪最大似然回归分析。
住院死亡病例是否进行了尸检。
在医院死亡病例中，0.9%（319/35272）的病例进行了尸检。尸检决策与已婚（比值比[OR]=1.60，95%置信区间[CI]：1.16至2.21）、自费（OR=1.56，95%CI：1.07至2.26）、因外部损伤和中毒导致的死亡（OR=1.69，95%CI：1.02至2.81）以及妊娠（OR=13.58，95%CI：4.94至37.36）呈显著正相关，但与年龄（OR=0.97，95%CI：0.96至0.98）、急诊入院（OR=0.66，95%CI：0.49至0.88）、转诊（OR=0.47，95%CI：0.25至0.88）、肿瘤（OR=0.35，95%CI：0.22至0.56）、呼吸系统疾病（OR=0.49，95%CI：0.26至0.95）和营利性医院（OR=0.45，95%CI：0.23至0.91）呈负相关。大型教学医院与其他医院的尸检率在统计学上无显著差异。
医院死亡病例的尸检率极低，主要原因在于医疗服务提供者。即使在控制了患者特征后，大型教学医院与其他医院相比，也未要求进行更多的尸检。迫切需要做出更多努力，鼓励医院和医疗服务提供者积极要求进行尸检，以重振这一重要程序。
