Clinical outcome versus post-mortem finding in thoracic surgery: a 10-year experience.

Objectives: The role of post-mortem following thoracic surgery has not been previously studied. Most importantly, the clinical diagnosis of thoracic surgical mortality cannot be certain unless post-mortem analysis has been performed.

Methods: Consecutive post-mortem data were collected on 110 patients between 1992 and 2001 (66.3% of all in-hospital thoracic surgical deaths). Clinically attributed causes of death were compared with post-mortem findings.

Results: A total of 4302 thoracic operations were performed during the 10-year period, with overall mortality 3.8%. The mean age was 63.6 years (range 21-87) with 73.6% male. In the 110 patients undergoing post-mortem examination, the operations performed were pneumonectomy 24.5%, lobectomy 14.5%, oesophagectomy 12.7%, lung biopsy 8.2%, pleurectomy/bullectomy 6.4%, decortication 4.5%, lung volume reduction 1.8%, other thoracic 13.6%, other oesophageal 9.1%, and other procedures 4.5%. The mean time to death was 12.5 days (range 0-85). The causes of death were respiratory 47.3%, cardiac 16.4%, multiple organ failure 8.2%, sepsis 6.4%, gastrointestinal 4.5%, haemorrhage/technical failure 10%, and others 7.3%. Post-mortem revealed an unsuspected cause of death in 34 (31%) patients, comprising pulmonary 17, cardiac 5, gastrointestinal 3, haemorrhage/technical failure 2, multiple organ failure 2 and other 5.

Conclusion: Post-mortem determined unsuspected diagnoses in a high proportion of patients undergoing thoracic surgery. Post-mortem continues to be the 'gold standard' method for attributing the cause of death. Accurate outcome data following thoracic surgery are essential for proper audit, and hence for improvements in clinical practice to occur.