A surgeon’s guide to peri-operative death

Peri-operative deaths are a highly emotive issue with devastating consequences for the family and for the medical and nursing staff who have looked after the patient. They are being increasingly scrutinized. Some of these deaths are inevitable and largely attributable to underlying pathology of an advanced or complex nature; others occur as a result of inexpert care or surgical mishap. For the latter the autopsy is of particular value, establishing the cause of death for the family and educating the surgical staff so that mistakes can be avoided in the future. A knowledge of the risk factors for a poor surgical outcome, and how they are identified and evaluated, will help the pathologist to advise the Coroner in particular in identifying those deaths that have arisen as a consequence of recognized complications of necessary medical treatment. Further, and even more importantly, the autopsy may identify factors avoidable in subsequent operations and thus benefit the living. This review discusses the most common causes of peri-operative death, and considers preventative measures, scoring systems and surgical audits designed to improve outcomes.