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Forensic pathology

Intra-operative and Post-operative deaths

Intra-operative deaths

Reviewer: Terrill L. Tops, M.D. (see Reviewers page)
Revised: 3 February 2013, last major update January 2013
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Intraoperative deaths can occur both in emergency (e.g., treating a gunshot wound/GSW to the chest) or non-emergency (e.g., open heart valvoplasty) surgical situations
● In general, the surgical procedure (e.g., specific organ operated on or type of instruments used); type of anesthesia (local or general) or contrast dye (i.e., iodine) all have risks that could lead to unexpected sudden death
● Non-emergency or elective surgical procedures require a signed informed consent from the patient stating the risks involved; if not, the consent may be signed by the next-of-kin or power-of-attorney
● Recently, there has been a significant drop in intraoperative deaths due to the routine use of surgical and anesthesiology safety check lists to avoid potential errors
● Multiple factors can increase the risk of intraoperative deaths, such as age, person's state of health, co-morbidities, genetic factors, tobacco use, alcoholism, history of illicit drug abuse, past medical noncompliance issues, etc.
● Deaths from improper intubation during a medical/surgical emergency does not necessary mean that the person performing the procedure was incompetent

Causes of death
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● Generally, in decreasing order, most intra-operative deaths are due to:

Complications from the disease itself, such as:
    ● ARDS during a bariatric gastric bypass procedure
    ● Air embolism to the heart during thoracic surgery
    ● Malignant hyperthermia from general anesthesia
    ● Ischemic stroke during IVC filter placement
  ● Manner of death is usually "Natural"

Human error that occurs outside the standard level of medical/surgical practice (a.k.a. medical malpractice), such as:
    ● Perforating the heart using the wrong surgical instrument
    ● Wrong dose of intraoperative anesthesia
  ● Manner of death is usually "Accident"

Death from undetermined cause(s)
    ● All possible causes of death have been ruled out

● Despite no surgical/anesthesiology errors occurring, patients may still die intraoperatively

Post-operative deaths

General
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● Deaths that occur immediately after surgical procedure (hours) or during immediate post-operative (days/weeks) hospitalization

Causes of death
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Natural cause of death:
● Intracranial surgery: sepsis, hemorrhage
● Thoracic surgery: ARDS, pneumonia, acute myocardial infarction/arrhythmia
● Intra-abdominal surgery: peritonitis/sepsis

Accidental cause of death:
● Given wrong dose of medication
● Given wrong medication

End of Forensic pathology > Intra-operative and Post-operative deaths

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