SWK - Non inquest findings

78y · Female·multi-organ failure due to haemorrhage into the abdomen, pelvis and retroperitoneum following lumbosacral spinal surgery; refusal of blood transfusion was a significant contributing condition

78-year-old Jehovah's Witness died from multi-organ failure secondary to intra-abdominal and retroperitoneal haemorrhage following extensive anterior and posterior lumbar spinal fusion surgery. The patient had multiple comorbidities, previous spinal surgery with persistent pain, osteoporosis, and religious refusal of blood transfusion. During surgery, she became hypotensive and tachycardic during the posterior approach but surgery continued without re-exploration of the anterior site. Post-operative imaging failed to identify the bleeding source, though autopsy revealed significant haemorrhage. Expert reviewers disagreed on whether the surgery was justified: one neurosurgeon considered it clinically unwise given age, comorbidities, and refusal of transfusion, while a spinal surgeon deemed it technically reasonable given Dr M's extensive experience and thorough informed consent. Key learning: extreme caution required before major elective spinal surgery in elderly patients with multiple comorbidities and religious contraindications to blood products; intraoperative haemodynamic deterioration warrants prompt re-exploration when alternative causes excluded.