Abstract
Autopsy rates worldwide have dropped significantly over the last five decades. Imaging based autopsies are increasingly used as alternatives to conventional autopsy (CA). The aim of this study was to investigate the effect of the introduction of minimally invasive autopsy, consisting of CT, MRI and tissue biopsies on the overall autopsy rate (of CA and minimally invasive autopsy) and the autopsy rate among different ethnicities. We performed a prospective single center before-after study. The intervention was the introduction of minimally invasive autopsy as an alternative to CA. Minimally invasive autopsy consisted of MRI, CT, and CT-guided tissue biopsies. Autopsy rates over time and the effect of introducing minimally invasive autopsy were analyzed with a linear regression model. We performed a subgroup analysis comparing the autopsy rates of two groups: a group of western-European ethnicity versus a group of other ethnicities. Autopsy rates declined from 14.0% in 2010 to 8.3% in 2019. The linear regression model showed a significant effect of both time and availability of minimally invasive autopsy on the overall autopsy rate. The predicted autopsy rate in the model started at 15.1% in 2010 and dropped approximately 0.1% per month (β = -0.001, p < 0.001). Availability of minimally invasive autopsy increased the overall autopsy rate by 2.4% (β = 0.024, p < 0.001). The overall autopsy rate of people with an ethnic background other than western-European was significantly higher in years when minimally invasive autopsy was available compared to when it was not (22/176 = 12.5% vs. 81/1014 (8.0%), p = 0.049). The introduction of the minimally invasive autopsy had a small, but significant effect on the overall autopsy rate. Furthermore, the minimally invasive autopsy appears to be more acceptable than CA among people with an ethnicity other than western-European.
Highlights
Introduction[1,2,3,4,5,6] Improvements in imaging techniques in living patients may have led to the belief that autopsies hardly add to the information acquired prior to death
The linear regression model showed a significant effect of both time and availability of minimally invasive autopsy on the overall autopsy rate
The overall autopsy rate of people with an ethnic background other than western-European was significantly higher in years when minimally invasive autopsy was available compared to when it was not (22/176 = 12.5% vs. 81/1014 (8.0%), p = 0.049)
Summary
[1,2,3,4,5,6] Improvements in imaging techniques in living patients may have led to the belief that autopsies hardly add to the information acquired prior to death. The low consent rate of next-of-kin for the autopsy is one of the reasons for the decline in clinical autopsy rates. Strategies to improve the consent rates are under investigation: improved availability of modern imaging techniques has led to the development of imaging-based autopsy techniques. Such methods can be non-invasive or minimally invasive [12]; in our hospital we introduced and validated a minimally invasive autopsy, consisting of postmortem CT, MRI and CT-guided biopsies. We used a questionnaire to investigate the motivations of doctors and next-of-kin in the consent process for postmortem investigation
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