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J Crit Care. 2013 Aug;28(4):421-6. doi: 10.1016/j.jcrc.2012.10.068. Epub 2013 Jan 9.

The clinical quandary of counseling the moribund critical care patient-a registry analysis of postsurgical outcomes.

Author information

  • 1Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA. saagerl@ccf.org

Abstract

PURPOSE:

To provide outcomes data to intensivists and surgeons for counseling patients and family members when considering a surgical intervention in a moribund patient.

MATERIALS AND METHODS:

Retrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database in moribund patients undergoing general surgical procedures.

RESULTS:

Out of 633,262 patients available in the national registry, 2063 (0.3%) were of moribund status. Post-operative mortality was 52.8% for moribund patients. Those who died had higher rates of compromised respiratory, renal and cognitive dysfunction, were older, less independent prior to surgery and had generally longer surgeries. 83% of patients experienced a major complication including mortality and 17 % of patients experienced minor complications.

CONCLUSION:

The moribund patient is not as grave as once thought and surgery on these patients may not be futile given the 47% survival rate at 30 days. Postoperative complication rates are high. The data presented provide a meaningful tool for the clinicians in counseling patients and families on the expectations when considering a surgical intervention for moribund patients.

Copyright © 2013 Elsevier Inc. All rights reserved.

KEYWORDS:

Clinical ethics; Critical ill; End-of-life care; Mortality; Terminal care

PMID:
23312126
[PubMed - indexed for MEDLINE]
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