Coronial
QLDhospital

PG - Non-inquest findings

Deceased

PG

Demographics

75y, male

Coroner

McDougall

Date of death

2013-05-07

Finding date

2017-05-24

Cause of death

left retroperitoneal haemorrhage associated with lumbar spine surgery

AI-generated summary

A 75-year-old man with complex comorbidities including Parkinson's disease and cognitive impairment underwent two-stage lumbar spine surgery for degenerative disc disease with stenosis. Post-operatively, he developed a retroperitoneal haemorrhage which was not identified until 6 days after surgery. An expert neurosurgeon questioned whether the extensive surgical approach was appropriate given his comorbidities and stable spine, suggesting a simpler laminectomy would have sufficed. The coroner found that while earlier CT imaging on post-operative day 4 might have identified the haemorrhage sooner, the standard of care was not breached. Clinical lessons include: considering less extensive surgical options for medically complex elderly patients; earlier imaging when post-operative abdominal symptoms persist despite initial investigation; and careful risk-benefit analysis of anticoagulation in post-operative patients at high bleeding risk.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

neurosurgeryintensive carenephrologyanaesthesiaurology

Error types

diagnosticdelay

Drugs involved

heparin

Clinical conditions

retroperitoneal haemorrhagelumbar degenerative disc diseasespinal canal stenosisacute renal failurepulmonary embolism

Procedures

lumbar interbody fusionlumbar laminectomylumbar discectomy

Contributing factors

  • retroperitoneal haemorrhage from lumbar spine surgery
  • delayed identification of haemorrhage (6 days post-operatively)
  • anticoagulation therapy with heparin post-operatively
  • complex comorbidities including Parkinson's disease and cognitive impairment
  • inability to mobilise post-operatively increasing thromboembolism risk
  • cessation of anticoagulation once haemorrhage recognised created risk of pulmonary embolism
Full text

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