At present in England and Wales just over 20% of all deaths are followed by a post mortem examination, almost all on the instructions of a coroner. In contrast, in Scotland and Northern Ireland the rates are below 10%. In a wider context overall post mortem rates in the provinces of Canada vary between 5–9% and are probably much lower in France and Germany. The reasons for this variation are unknown. Remarkably there has been no national audit of the indications for, or value of, autopsy examination. In this review we consider:

• why autopsies should be performed after cardiac surgery

• who should perform these autopsies and how they should be reported

• what has been learnt from post mortem examinations performed on patients dying after cardiac surgery

• what the role of these autopsies is in the future.

POST MORTEM EXAMINATION AFTER SURGERY

Pathologists frequently refer to the many published studies which have shown that important new information is detected in autopsies performed in patients dying in hospital.¹ At least two have shown that the rate of unexpected findings has not altered significantly over several decades.^2,3 Methods have been developed to categorise the degree of concordance between pre-mortem clinical diagnoses and post mortem findings.² A recent meta-analysis identified discrepancies in 10–20.6% of post mortem examinations where the patient would potentially have survived if the correct diagnosis had been known in life.⁴ Although most of these studies have included patients dying after surgery, there have been few that specifically studied the value of post mortem examination after surgery.^5,6

A retrospective study from Connecticut studied the clinical records and post mortem reports of 150 patients who died in a surgical intensive care unit. There was full agreement in only 58% of cases. The longer the patient was in the unit the greater …