Decessi in corso di intervento chirurgico: studio casistico ed aspetti medico-legali

After discussing the factors that determine surgical and anaesthetic operating risk, the Authors examine cases of intraoperative death gleaned from post mortem carried out by Milan's forensic medicine authority over the period 1987-1996. To obtain a sufficiently homogeneous sample they only considered cases of death during operation and excluded those occurring in the post-operative course, as it is not possible to distinguish, after the fact, deaths attributable to iatrogenic error or complications from those due to other causes. In the period under examination, 41 intraoperative deaths were found out of a total of 14,695 autopsy reports. In 15 of these (36.5%) the post mortem pointed to malpractice in the form of an obvious technical error by the surgeon or anaesthetist, whereas in 10 cases (24.5%) the cause of death was judged to stem from an abnormal subjective response to the anaesthesia administered, in which case the issue of malpractice attaches to the actual decision to operate rather than to any technically reprehensible action. In 7 cases (17%) the deaths were 'foretold', given the high degree of operating risk. And in the remaining cases deaths was due either to massive pulmonary thromboembolism in old patients or, in a very small number of cases, to unspecified causes. It is worth considering, however, that the deaths which reach the attention of forensic medicine are only a mere indication of a more complex social and health situation. While some complaints may be unjustified, we may assume that a number of operating deaths due to iatrogenic causes were not recognized as such and were passed over in silence. These considerations are proffered to invite wider reflection on the whole theme of operating risk