Autopsy rate and a clinicopathological audit in an Australian metropolitan hospital--cause for concern?

Abstract

Objectives: To determine the annual autopsy rates at five major Melbourne teaching hospitals between 1979 and 1989; to investigate the cause(s) of the decline in autopsy rates during that period; and to assess the importance of autopsies at the index hospital by a clinicopathological audit.

Design: Retrospective data for annual autopsy rates (i.e. all patients undergoing autopsy as a ratio of the total number of deaths) were obtained for five hospitals and, for the index and one other hospital, demographic data for autopsy rates within certain ethnic and religious groups for 1988. For the clinicopathological audit, clinical diagnoses from hospital charts and death certificate diagnoses were compared with the major findings for all autopsies in 1988.

Setting: The index and the other four hospitals are major Melbourne metropolitan teaching hospitals.

Patients: For the index hospital in 1988, demographic data for age, sex, death in a surgical or medical unit were obtained for 643 deceased patients, of whom 124 underwent a hospital autopsy. Data of ethnic background and religion were available for 557 of 643 deceased patients. At another hospital, religious affiliation was obtained for all patients who died in hospital (543) for 1989.

Results: Between 1979 and 1989, the autopsy rate declined from 47% to 19% at the index hospital, by relative levels of 50% at three hospitals, and showed a smaller decline at the fourth. At the index hospital in 1988, permission for autopsy was sought in 84% of deceased patients, but was granted in only 22%. The audit showed that major misdiagnoses occurred in 18 of 124 cases (14.5%), with relevance to patient management in eight cases (6%).

Conclusions: The falling autopsy rate at five major teaching hospitals could be attributed to the relatively low status of the autopsy among clinicians and pathologists and the high refusal rates by relatives of the deceased since the introduction in 1983 of the Human Tissue Act 1982 (Vic.). The audit corroborated the importance of autopsies as a diagnostic tool.