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Deaths associated with surgery and anaesthesia

  • Procedure

The autopsy of a patient who dies during or after surgery separates the underlying disease, a recognised complication and a possible error.

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What it is

When a patient dies during surgery or a procedure, or shortly after, the question is whether death was due to the disease that led to the operation, a recognised complication of the procedure, the anaesthetic or a possible error. In Colombia, when the death is suspected to have been caused by a medical act, the medico-legal autopsy is mandatory. This autopsy requires a thorough knowledge of the history: the procedure, the devices placed, the timings and the anaesthetic record. Autopsy series show major discrepancies between the clinical diagnosis and the findings, especially for haemorrhage, sepsis, pulmonary embolism and anastomotic leaks. A complication does not by itself mean negligence: that is decided by the authority with all the evidence.

What to document

  • The position and function of each device: endotracheal tube, venous catheters, drains.
  • The time between the procedure and death, and the clinical course.
  • The findings that explain the death and the negative findings that rule out other causes.
  • Resuscitation injuries, so they are not mistaken for procedural injuries.
  • The state of the samples and their chain of custody.

How it is done

  1. Obtain the complete medical record, the anaesthetic record, the operation note and the list of devices and drugs.
  2. Leave tubes, catheters, drains and probes in place and document their position before removing them.
  3. If air embolism or pneumothorax is suspected, image before opening or open the chest under water to see the air escape.
  4. Examine the operative site: sutures, anastomoses, haemostasis, foreign bodies and collections.
  5. Measure the blood in the body cavities and find the source of any haemorrhage.
  6. Look for thrombi in the deep veins and emboli in the pulmonary arteries, and examine the heart with histology.
  7. Take samples for toxicology, microbiology and histology, including the operated organs.
  8. In the report, separate the underlying disease, procedural injuries, resuscitation injuries and the cause of death.

Next step: what to do and document

  • After a death in theatre or recovery, do not issue a natural-death certificate if a link with the procedure is suspected: inform the Fiscalía.
  • Hand the complete medical record to the institution's director at once for safekeeping (Decree 786 of 1990, art. 8, paragraph 1), and do not change it later without recording the date, time and reason.
  • Leave tubes, catheters and drains in place, and keep the drugs, infusion bags and equipment used.
  • Tell the family truthfully what happened and report the adverse event through the institution's channels.
  • Anyone involved in the patient's care should not perform the autopsy: the expert must be independent.
  • Official text checked on 2026-11-13 at funcionpublica.gov.co.

Common mistakes

  • Removing devices before the autopsy and losing the evidence of their position.
  • Opening the chest without preparing to look for air when air embolism is suspected.
  • Mistaking resuscitation injuries for surgical or traumatic injuries.
  • Concluding negligence in the report: the expert describes cause and mechanism; liability is for the judge.

Test yourself

Think of the answer, then tap the question to see it.

What is done with the tubes and catheters of a patient who dies after surgery, before the autopsy?

They are left in place, to document their position and rule out misplacement.

When is a medico-legal autopsy mandatory in a perioperative death in Colombia?

When the death is suspected to have been caused by a medical act (Decree 786 of 1990, art. 7(e)).

How is air embolism shown at autopsy?

With imaging before the body is opened, or by opening the chest and heart under water to see bubbles escape.

Is it the expert's job to decide whether there was negligence?

No. The expert describes the cause, mechanism and findings; liability is decided by the judicial authority with all the evidence.

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Post-surgical Autopsy Findings: Insights Into Forensic Evaluation and Surgical Complications (Cureus (PMC), 2025); Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016) (Función Pública, Gestor Normativo, 1990).

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