Autopsy rates in the Netherlands: 35 years of decline.

Britt M Blokker,J Wolter Oosterhuis,Annick C Weustink,M G Myriam Hunink,Jefferson Terry

doi:10.1371/journal.pone.0178200

Britt M Blokker, J Wolter Oosterhuis + Show 3 more

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https://doi.org/10.1371/journal.pone.0178200

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Abstract

ObjectiveAlthough the autopsy still is a valuable tool in health statistics, health care quality control, medical education, and biomedical research, autopsy rates have been declining worldwide. The aim of this study was to examine trends of overall, clinical and forensic autopsy rates among adults in the Netherlands over the last four decades, and trends per sex, age (groups), and hospital type.MethodsWe performed a retrospective study covering 35 years of Dutch national death counts (1977–2011), the number of in-hospital deceased patients, the number of deaths due to external causes, and the proportion of autopsies performed in these populations. The effects of sex, age and hospital category were analysed by linear and logistic regression and differences were evaluated by chi-square tests.ResultsOverall autopsy rates declined by 0.3% per calendar year, clinical autopsy rates by 0.7% per calendar year (from 31.4% to 7.7%), and forensic autopsy rates did not decline. Per calendar year the fraction of in-hospital deceased patients decreased by 0.2%. Autopsy rates were highest among men and younger patients; clinical autopsy rates were highest for patients dying in academic hospitals.ConclusionsIn the Netherlands clinical autopsy rates have rapidly declined while at the same time the fraction of in-hospital deaths decreased, both contributing to the overall reduced absolute number of autopsies performed. It is important to improve awareness among both clinicians and general practitioners of the significance of the clinical autopsy.

Highlights

BackgroundThe relevance of the clinical autopsy is well recognized; it provides bereaved relatives with information on the cause of death and clinicians with feedback on diagnosis and treatment, making it an important instrument for health care quality control [1, 2]
In the Netherlands clinical autopsy rates have rapidly declined while at the same time the fraction of in-hospital deaths decreased, both contributing to the overall reduced absolute number of autopsies performed
These variables were derived from logbooks of the Netherlands Forensic Institute (NFI), and databases provided by Statistics Netherlands

Summary

Introduction

BackgroundThe relevance of the clinical autopsy is well recognized; it provides bereaved relatives with information on the cause of death and clinicians with feedback on diagnosis and treatment, making it an important instrument for health care quality control [1, 2]. The autopsy improves the accuracy of both death certificates [7] and epidemiologic databases [8] It contributes to medical knowledge [9] provides for evidence-based research, and is a resource for biomedical research, e.g. by procurement of normal and pathological tissues [10]. Despite these benefits, clinical autopsy rates have rapidly declined worldwide in the past decades, and alternative less invasive post-mortem methods are currently being developed to improve or replace the conventional autopsy [11]. Few studies have reported on Dutch autopsy rates [2, 18] and only one study evaluated potential factors that might have influenced autopsy rates, based on a small population in the early sixties [19]

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