Is medical postmortem practice dying? An audit on postmortems in the department of anatomical pathology, university of the Witwatersrand, Johannesburg, South Africa.

Abstract

An audit of postmortems performed in the Division of Anatomical Pathology, University of the Witwatersrand, between January 2009 and December 2018 at Charlotte Maxeke Johannesburg Academic Hospital, and Chris Hani Baragwanath Academic Hospital was performed.

Background: There is a worldwide downward trend in medical autopsies, however, autopsy remains the gold standard to determine the cause of death. There is presently limited data available on the practice of medical autopsies in South Africa.

Aims and Objectives: Trends in the number of autopsies performed, demographic data and causes of death over a 10-year period between 2009 and 2018 were assessed.

Methods: A retrospective, descriptive review of all postmortem reports over a ten-year time period.

Results: A total of 889 autopsies were performed during the study period. The annual number of postmortems ranged from a maximum of 126 autopsies performed in 2009, the beginning of the study period, to a minimum of 68 in 2016 and 2018, towards the end of the study period. Adult autopsies comprised the majority of cases (66.25%), however, this age group showed a relatively larger decline from 91 (72.22%) cases in 2009 to 37 (54.41%) cases in 2018 compared to the paediatric and neonatal age groups. The most common immediate causes of death were related to the circulatory system (36%), infectious disease (29%) and unknown/indeterminate (16%). Diseases related to infections (23%), the circulatory system (16%) and unknown/indeterminate (12%) were the most common underlying causes of death.

Conclusion: This study shows a significant decline in autopsy numbers in our Division. It elucidates epidemiological data and the spectrum of causes of death and how these epidemiological patterns have changed over the 10-year study period.