Autopsy rates and diagnostic errors in a Swiss community hospital: a ten-year retrospective analysis

Historically, autopsy has served as a procedure to determine the cause of death. With the surge in diagnostic techniques and a change in mindset, autopsy rates have decreased globally to less than 10%. Besides providing the cause of death and insights into disease mechanism, autopsy may assess clinical performance via discrepancy analysis. The objectives of our study were to determine autopsy rates in a Swiss community hospital and major discrepancies between clinical and autopsy reports according to the Goldman classification. Of 1711 registered in hospital deaths between 2012 and 2021, 123 patients were subjected to autopsy, resulting in an average autopsy rate of 7.2%. Younger patients had higher autopsy rates (17.0% for patients aged 50-59 years), and sex-adjusted male-to-female autopsy rate was 1.6. Major discrepancies were identified in 18 cases (14.6%); 10 (8.1%) class I, and 8 (6.5%) class II errors. Complete agreement was reached in 74 cases (60.2%), and 31 cases (25.2%) were classified as indeterminate category VI. The most frequent class I errors were infectious diseases (n = 5) with two cases of endocarditis, two cases of aspergillosis, and one case of perforated diverticulitis. The most frequent class II error was advanced malignant disease (n = 4). In conclusion, the autopsy rate at our hospital was at the higher end of other contemporary reports, and major discrepancy rates occurred at a comparably low frequency. Nevertheless, the study revealed that despite extensive diagnostics, cases prone to misdiagnosis still exist. In this context, autopsy represents an important tool for quality control.