Forensic pathology
Types of injuries
Intraoperative and Postoperative deaths

Author: Terrill L. Tops, M.D. (see Authors page)

Revised: 12 January 2017, last major update January 2013

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed search: intraoperative death forensic

Cite this page: Intraoperative and Postoperative deaths. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/forensicsintrapostopdeaths.html. Accessed September 20th, 2017.
Intraoperative deaths
General
  • Intraoperative deaths can occur both in emergency (e.g. treating a gunshot wound / GSW to the chest) or nonemergency (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
  • Nonemergency 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, comorbidities, 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
  • Generally, in decreasing order, most intraoperative 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

Postoperative deaths
General
  • Deaths that occur immediately after surgical procedure (hours) or during immediate postoperative (days / weeks) hospitalization
Causes of death
Natural cause of death:
  • Intracranial surgery: sepsis, hemorrhage
  • Thoracic surgery: ARDS, pneumonia, acute myocardial infarction / arrhythmia
  • Intraabdominal surgery: peritonitis / sepsis

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