病理解剖に関するアンケート調査結果と剖検に関する一考察

Abstract

The rate of autopsies of patients dying in hospital has now decreased not only in Japan but also in the United States and European countries. Nara Medical University Hospital now averages an autopsy rate of about 10% for the last several years. We sent out a questionnaire on autopsy to all 80 Medical University Hospitals in Japan, and received replies from 65 University Hospitals (81%). Autopsy time schedule, number of participant pathologists and autopsy assistants were very variable from hospital to hospital. Autopsy time schedules of the hospitals were classified into four groups. Seven university hospitals have performed autopsy on business time schedules only, eleven hospitals on business time schedules including Saturdays, forty hospitals on daytime schedules irrespective of off-days and holidays, and the remaining seven hospitals on 24-hour schedules. However, the most interesting point was that the mean autopsy rate was not fundamentally different in the 4 groups with different autopsy time schedules, that is; 16.3%, 19.7%, 16.4%, and 18.9%, respectively. The number of pathologists and, especially, autopsy assistants is insufficient to establish a 24-hour autopsy system at present in Nara Medical University Hospital. Cooperation with clinicians and reconsideration of the allotted jobs of paramedical technologists in the university hospital are indispensable to perform autopsies on a 24-hour schedule system in our university hospital. When it is not possible to perform a complete autopsy, less invasive or non-invasive alternatives to the complete autopsy, such as limited autopsy, needle autopsy, endoscopic autopsy, and autopsy imagings using CT and/or MRI, may be valqable tools capable of answering specific questions in situations.