Postoperative outcomes in patients with a do-not-resuscitate (DNR) order undergoing elective procedures.
J Clin Anesth
; 48: 81-88, 2018 Aug.
Article
in En
| MEDLINE
| ID: mdl-29783184
ABSTRACT
STUDY OBJECTIVE:
Do-not-resuscitate (DNR) status has been shown to be an independent risk factor for mortality in the post-operative period. Patients with DNR orders often undergo elective surgeries to alleviate symptoms and improve quality of life, but there are limited data on outcomes for informed decision making.DESIGN:
Retrospective cohort study.SETTING:
A multi-institutional setting including operating room, postoperative recovery area, inpatient wards, and the intensive care unit. PATIENTS A total of 566 patients with a DNR status and 316,431 patients without a DNR status undergoing elective procedures using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2012.INTERVENTIONS:
Patients undergoing elective surgical procedures. MEASUREMENTS We analyzed the risk-adjusted 30-day morbidity and mortality outcomes for the matched DNR and non-DNR cohorts undergoing elective surgeries. MAINRESULTS:
DNR patients had significantly increased odds of 30-day mortality (OR 2.51 [1.55-4.05], pâ¯<â¯0.001) compared with non-DNR patients. In the DNR versus non-DNR cohort there was no significant difference in the occurrence of a number of 30-day complications, the rate of resuscitative measures undertaken, including cardiac arrest requiring CPR, reintubation, or return to the OR. The most common complications in both DNR and non-DNR patients undergoing elective procedures were transfusion, urinary tract infection, reoperation, and sepsis. Finally, the DNR patients had a significantly increased total length of hospital stay (7.65⯱â¯9.55 vs. 6.87⯱â¯9.21â¯days, pâ¯=â¯0.002).CONCLUSIONS:
DNR patients, as compared with non-DNR patients, have increased post-operative mortality but not morbidity, which may arise from unmeasured severity of illness or transition to comfort care in accordance with a patient's wishes. The informed consent process for elective surgeries in this patient population should include a discussion of acceptable operative risk.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Postoperative Complications
/
Resuscitation Orders
/
Outcome Assessment, Health Care
/
Elective Surgical Procedures
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Clin Anesth
Journal subject:
ANESTESIOLOGIA
Year:
2018
Type:
Article