Death in the OR

I’d say it’s not very common. My facility does about 30,000 procedures annually. We have maybe at max 5 deaths a year, probably less (not including organ procurement). I would say what happens after will depend a bit on the manner.

A homicide we don’t do anything with- the medical examiner has picked them up retractors still in place and everything.

Other traumas not involving criminal acts the surgeon, resident, or PA will close. The team in the room takes care of postmortem care, but in the vast majority (if not all) of these cases all lines and drains stay put. Then our OR aides take them to the morgue for later pick up by medical examiner. 

Things like ruptured aortic aneurysms or other similar situations where expected survival rate is very low typically are determined not to need an autopsy, so we can pull all lines and drains and do thorough clean up. 

Unexpected events like someone randomly coding during surgery are treated like the traumas not involving criminal acts. 

I would say that most of the time if the surgeon realizes that surgery is futile, they’re going to try to get the patient out of the OR and into ICU or PACU so that family can be with them at the end. These would typically be the emergency cases, not routine scheduled cases. I actually had a patient, unconscious and obviously unable to consent, who was in the cath lab with a left main unable to be stented- got them into the OR and started prepping fro surgery under the assumed consent as no next of kin were available. Before we got to the point of making incision, next of kin said to stop. So we did, packed the patient up, and took them to ICU. Most likely they technically expired during transport but we got them to family and since we’d exited the OR, it wasn’t an OR death. 

On 3/13/2021 at 8:51 AM, Rose_Queen said:

I’d say it’s not very common. My facility does about 30,000 procedures annually. We have maybe at max 5 deaths a year, probably less (not including organ procurement). I would say what happens after will depend a bit on the manner.

A homicide we don’t do anything with- the medical examiner has picked them up retractors still in place and everything.

Other traumas not involving criminal acts the surgeon, resident, or PA will close. The team in the room takes care of postmortem care, but in the vast majority (if not all) of these cases all lines and drains stay put. Then our OR aides take them to the morgue for later pick up by medical examiner. 

Things like ruptured aortic aneurysms or other similar situations where expected survival rate is very low typically are determined not to need an autopsy, so we can pull all lines and drains and do thorough clean up. 

Unexpected events like someone randomly coding during surgery are treated like the traumas not involving criminal acts. 

I would say that most of the time if the surgeon realizes that surgery is futile, they’re going to try to get the patient out of the OR and into ICU or PACU so that family can be with them at the end. These would typically be the emergency cases, not routine scheduled cases. I actually had a patient, unconscious and obviously unable to consent, who was in the cath lab with a left main unable to be stented- got them into the OR and started prepping fro surgery under the assumed consent as no next of kin were available. Before we got to the point of making incision, next of kin said to stop. So we did, packed the patient up, and took them to ICU. Most likely they technically expired during transport but we got them to family and since we’d exited the OR, it wasn’t an OR death. 

Yes - @Rose_Queen is right - actual DOTs (Death on Table) are pretty rare. Trauma (GSWs, MVAs and other things like rAAAs) account for about 60% of our DOTs each year. 30% is high-risk elective open CVOR cases - re-do’s (had a pt pass during 4th re-do CABG x 4), huge aortic cases requiring DHCA, and other open cases involving the aorta.  The remaining 10% are misc., with Liver Transplants, Whipples w/ portal vein involvement, 2F / 3F open esophagectomies and large open abdominal cases (debulking for metastatic cancer) making up the vast majority.

Greetings RNdreams7, RN:  

Great discussion and yes, very difficult situation for all involved.  My response is from that as a medicolegal death investigator (MDI) with academic preparation and practice as a nurse.  Most deaths that occur within an OR are reportable to the medical examiner/coroner/justice of peace (depending upon the jurisdiction). The rationale for the patient death being reportable is for several reasons: 1) was the initial reason for hospitalization due to injury/trauma 2) was the death related to the procedure/anesthesia 3) some states require OR deaths be reported respective of the death being unrelated to items 1 or 2. Obviously, additional questions will occur between the MDI and reporting nurse.  I have typically taken these death reports from the circulating nurse and/or charge nurse and will frequently ask to speak with the surgeon and anesthesia/CRNA involved with the case. Additionally all medical interventions should remain in place and the patient transported to morgue.  It is likely initial biological specimens will be requested along with medical records to include the anesthesia report. I would be happy to address any other questions or assist you in understanding the process, if needed.