People With DNR Orders More Apt to Die After Any Surgery

MONDAY April 18, 2011 -- Patients with do-not-resuscitate (DNR) orders are more likely to suffer complications and die after surgery, even after non-emergency procedures, a new study finds.

DNR orders request that no "heroic" cardiovascular measures be used to revive someone who is clinically unresponsive and lacks a pulse.

The study appears online April 18 and in the August print issue of the journal Archives of Surgery.

Researchers analyzed data from 4,128 adult patients with DNR orders and 4,128 patients matched for age and type of procedure who had surgery at 120 U.S. hospitals between 2005 and 2008. Most of the patients were elderly white women, average age 79.

Patients outcomes were evaluated based on the occurrence of one or more postoperative complication, the need for another operation, total time in the operating room, length of hospital stay and death within 30 days of surgery.

The combined death rate for both groups of patients was 15.3 percent.

"Compared with non-DNR patients, more than twice as many DNR patients died within 30 days of surgery (8.4 percent versus 23.1 percent). The DNR patients were more likely to die regardless of the urgency of the surgical procedure" -- 35.5 percent versus 17.8 percent and 16.6 percent versus 5.5 percent for emergency and non-emergency procedures, respectively, wrote Hadiza Kazaure and colleagues at Yale University School of Medicine in a journal news release.

They also found that patients with do-not-resuscitate orders were more likely to die after every type of procedure included in the study.

The overall complication rate for both groups of patients was 28.6 percent, but the rate was higher in DNR patients (31 percent) than in non-DNR patients (26.4 percent).

The researchers noted that patients with DNRs undergo operations for a variety of reasons, ranging from palliative surgery to attempts to extend life.

"The DNR patients may have surgery to gain 'additional time'; nevertheless, our study demonstrates that almost a quarter of DNR patients die within 30 days of surgery," the study authors noted.

"Informed consent and elicitation of the goals of surgery, especially as they relate to overall goals of care, are essential for guiding surgical decisions involving DNR patients and their families. Issues pertaining to DNR status are complex, and they should be anticipated long before the 30-day period leading to an operation," the study authors concluded.

More information

The U.S. Agency for Healthcare Research and Quality has more about end-of-life treatment decisions.

Posted: April 2011


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