Format

Send to

Choose Destination
See comment in PubMed Commons below
Arch Surg. 2011 Aug;146(8):922-8. doi: 10.1001/archsurg.2011.69. Epub 2011 Apr 18.

High mortality in surgical patients with do-not-resuscitate orders: analysis of 8256 patients.

Author information

1
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.

Abstract

OBJECTIVE:

To evaluate outcomes of patients who undergo surgery with a do-not-resuscitate (DNR) order.

DESIGN:

Retrospective cohort study.

SETTING:

More than 120 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2008.

PATIENTS:

There were 4128 adult DNR patients and 4128 age-matched and procedure-matched non-DNR patients.

MAIN OUTCOME MEASURES:

Outcomes were occurrence of 1 or more postoperative complications, reoperation, death within 30 days of surgery, total time in the operating room, and length of stay. The χ(2) test was used for categorical variables and t and Wilcoxon tests were used for continuous variables. Multivariate logistic regression was done to determine independent risk factors associated with mortality in DNR patients.

RESULTS:

Most DNR patients were white (81.5%), female (58.2%), and elderly (mean age, 79 years). Compared with non-DNR patients, DNR patients experienced longer length of stay (36% increase; P < .001) and higher complication (26.4% vs 31%; P < .001) and mortality (8.4% vs 23.1%; P < .001) rates. Nearly 63% of DNR patients underwent nonemergent procedures; they sustained a 16.6% mortality rate. After risk adjustment, DNR status remained an independent predictor of mortality (odds ratio, 2.2; 95% confidence interval, 1.8-2.8). American Society of Anesthesiologists class 3 to 5, age older than 65 years, and preoperative sepsis were among independent risk factors associated with mortality in DNR patients.

CONCLUSIONS:

Surgical patients with DNR orders have significant comorbidities; many sustain postoperative complications, and nearly 1 in 4 die within 30 days of surgery. Do-not-resuscitate status appears to be an independent risk factor for poor surgical outcome.

PMID:
21502441
DOI:
10.1001/archsurg.2011.69
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Support Center