Negligent homicide in paediatric surgery cases found in autopsies

Abstract

Background: Paediatric surgical patients are vulnerable to perioperative morbidity and mortality. In low-resource settings, differentiating unavoidable surgical complications from potentially negligent death remains challenging. Autopsy findings may provide objective evidence of medical error, yet systematic prospective data linking autopsy-proven negligence to legal definitions of homicide are scarce. Objective: To determine the proportion and nature of negligent homicide among paediatric surgical autopsies. Methods: This prospective cohort study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. A total of 78 paediatric surgical deaths were included using purposive sampling. All cases underwent a complete medicolegal autopsy. Negligent homicide was defined as death directly caused by a healthcare provider’s action or omission deviating from the standard of care established by an independent expert panel reviewing clinical records and autopsy findings. Data were analyzed using SPSS version 23.0. Results: Among 78 autopsied paediatric surgical deaths, 23 cases (29.5%) met criteria for negligent homicide. Common contributory factors included unrecognized intraoperative bleeding (47.8%), retained surgical instruments (26.1%), wrong-site surgery (13.0%), and anaesthesia-related errors (13.0%). Most deaths occurred within 48 hours postoperatively (78.3%). Mean age was 4.2 years, with no significant sex predominance. Conclusion: Negligent homicide was identified in nearly one-third of paediatric surgical deaths autopsied in this cohort. Routine medicolegal autopsy combined with systematic case review can help distinguish negligence from unavoidable complications. Targeted perioperative safety protocols and training are urgently needed in similar low-resource settings.

Journal of Paediatric Surgeons of Bangladesh (2026) Vol. 17 (1): 83-87