Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
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SHR Neuro Krebs Kardio Lipid Stoffw Microb
Saager, L; Kurz, A; Deogaonkar, A; You, J; Mascha, EJ; Jahan, A; Turner, PL; Sessler, DI; Turan, A.
Pre-existing do-not-resuscitate orders are not associated with increased postoperative morbidity at 30 days in surgical patients
CRIT CARE MED. 2011; 39(5): 1036-1041.
Doi: 10.1097/CCM.0b013e31820eb4fc
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PubMed
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- Co-Autor*innen der Med Uni Graz
- Kurz Andrea
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- Abstract:
- Objective: To assess the relationship between pre-existing do-not-resuscitate orders and the incidence of postoperative 30-day minor morbidity in surgical patients. Design: Retrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database in patients undergoing general surgical procedures between 2005 and 2008. Setting: All U. S. hospitals that participated in the American College of Surgeons National Surgical Quality Improvement Program, which is the nationally validated, risk-adjusted, outcomes-based program that uses a prospective, peer-controlled, validated database to quantify 30-day risk-adjusted surgical outcomes, allowing valid comparison of outcomes among all hospitals in the program. Interventions: American College of Surgeons National Surgical Quality Improvement Program data included preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in both the inpatient and outpatient setting. The data were collected, validated, and submitted by a trained Surgical Clinical Reviewer at each site. Association between do-not-resuscitate status and minor and major morbidities was assessed using proportional hazards models adjusting for death as a competing risk. Measurements and Main Results: Of 635,265 patients in the database, 576,745 patients were analyzed. Propensity-matched analysis successfully matched 2,199 (of 2,687 [81.8%]) patients having pre-existing do-not-resuscitate orders (DNR group) with 6,002 non-do-not-resuscitate control subjects (nonDNR group). At any time point within 30 days of surgery, DNR patients were 16% (95% confidence interval, 3-28%; p = .02) less likely to have a minor complication as compared with nonDNR patients after accounting for the competing risk of death. DNR patients were more likely to experience 30-day mortality compared with nonDNR patients (hazard ratio, 2.3; 95% confidence interval, 1.9-2.7; p < .001). However, there was no association between pre-existing do-notresuscitate orders and occurrence of any major complication (p < .65) treating death as a competing risk event. When associations between do-not-resuscitate orders and individual minor complications were analyzed, a pre-existing do-not-resuscitate order remained independently associated only with decreased odds of superficial surgical site infection (p = .001). Conclusions: Undergoing surgery with a pre-existing do-notresuscitate order did not increase the risk of having a postoperative minor or major morbidity at any time within the 30-day postoperative period. Results of health care in U. S. hospitals do not differ based on presence of do-not-resuscitate orders. (Crit Care Med 2011; 39:1036-1041)
- Find related publications in this database (Keywords)
- do-not-resuscitate
- perioperative morbidity
- end-of-life care