Autopsies in the COVID era (community based hospital groups)

[univlad]

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Has your community based pathology group suspended hospital autopsies in the CoVID era? Or have you started to perform them on request now? What are your current criteria to perform an autopsy?

 

[Thr0mbus]

I will never do one of those again. Last time I did one was in residency. What a waste of time!! Reimbursement is a joke for them also!! BIG ACADEMIA IS A JOKE FOR MAKING US DO THEM!!!

 

[cmz]

None of our pathologists have credentials to do autopsies at any of the hospitals we practice at. Case closed.

 

[univlad]

None of our pathologists have credentials to do autopsies at any of the hospitals we practice at. Case closed.

I'm more interested in what community groups who were doing autopsies before March are doing now. Have you suspended the service or do you test and do only negative cases?

 

[Euchromatin]

As much as we would like to stop offering autopsies altogether, it is part of our contract with most of the hospitals we cover. Luckily volumes are usually pretty low - typically less than 5 adults per year.

We decided to suspend the service starting in March for the outbreak and initially this was implicitly accepted by hospital admin (they kept cancelling/putting off attempts to meet with them to discuss the issue and finalize the policy) - right up until a prominent surgeon insisted on having one done on one of their patients. The patient did have a negative SARS CoV2 test prior to surgery. Then suddenly hospital admin insisted that we offer one. Our morgue facility and PPE availability is right on the borderline of minimum acceptable per CDC guidelines for COVID from what I understand and we hadn't worried too much about changing things since we had previously thought that we wouldn't be doing them in the COVID era. So after some waffling around we ended up eating the cost to pay a local private autopsy service to do that one, but it was very expensive.

We have since decided we will probably do future requests ourselves (as long as pt was COVID negative) and made arrangements to improve safety somewhat.
I'm not quite sure what the status of the official policy documents are right now (not my responsibility) - I suspect something along the lines of considering requests on a case by case basis with discussion of risks and benefits - but unofficially the gist is that the hospital admin will go along with us in discouraging most autopsy requests unless it is coming from a surgeon (or other clinician that brings in a lot of $$ for the hospital) and they have a temper tantrum about it.

 

[LADoc00]

Stop doing autopsies period, unless you are paid a significant amount per case for them.

 

[deleted314957]

The last several years I was in practice, I took a different approach to the quite small number of adult autopsies there were. I did a “ problem/ question” oriented approach.
Basically, I would ask what the burning interest was and do a very limited incision to “ sample” tissue in- situ. This pleased folks ok.

 

[Path or bust]

I did a COVID autopsy in April (community practice 2-4 autopsies a year).

52 year old male with "no past medical history". Positive for COVID by PCR, D-dimer >3000, Ferritin >1000, absolute lymphocytopenia. Sent home after about a month, then returns with SOB but negative for COVID by PCR with sudden death next day.

Autopsy: large bilateral hemorrhagic cavitary infarctions of the lungs (8-10cm). No PEs that I observed grossly. Microscopically full of microthrombi throughout all the organs. Diffuse alveolar damage and pneumonia. LVH. What a mess. I obtained direct lung sample for PCR and cultures: Negative for COVID and positive for Cryptococcus neoformans.

 

[Alteran]

We dump the rare autopsies we get on the local training program and let them deal with it. Autopsies were never part of our contract and will never be because the hospital has no facility to do an autopsy.

 

[HeyDalaron]

I did a COVID autopsy in April (community practice 2-4 autopsies a year).

52 year old male with "no past medical history". Positive for COVID by PCR, D-dimer >3000, Ferritin >1000, absolute lymphocytopenia. Sent home after about a month, then returns with SOB but negative for COVID by PCR with sudden death next day.

Autopsy: large bilateral hemorrhagic cavitary infarctions of the lungs (8-10cm). No PEs that I observed grossly. Microscopically full of microthrombi throughout all the organs. Diffuse alveolar damage and pneumonia. LVH. What a mess. I obtained direct lung sample for PCR and cultures: Negative for COVID and positive for Cryptococcus neoformans.

Cryptococcus? That's strange.

 

[Path or bust]

Yeah the high dose steroids are leading

Cryptococcus? That's strange.

Yeah, the high dose steroids are leading to opportunistic infections

 

[y2k_free_radical]

Cryptococcus? That's strange.

I have had two cases of death from unexpected disseminated cryptococcal infection on autopsies i performed in the last two years.Neither were on steroid therapy.Both were young females with one being immediately postpartum.I also recently did an autopsy on a female who died of CORONA virus enterocolitis-she was embalmed.I am forced to do private autopsies to augment my ever dwindling surgical pathology earnings.

 

[deleted314957]

I have had two cases of death from unexpected disseminated cryptococcal infection on autopsies i performed in the last two years.Neither were on steroid therapy.Both were young females with one being immediately postpartum.I also recently did an autopsy on a female who died of CORONA virus enterocolitis-she was embalmed.I am forced to do private autopsies to augment my ever dwindling surgical pathology earnings.

[emoji22]

 

[univlad]

We're finally moving forward with outsourcing autopsies. We could send the bodies out of town to one service or have a local forensic pathologist do them in our morgue. Do you think a pathologist doing only occasional autopsies would be required to have medical staff privileges in the hospital?

 

[LADoc00]

How much would you charge to make a living off them?
5K?
6k?

there is like NO ONE doing them where I am.