Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order
Background. Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population.Methods. Using com...
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| Format: | Article |
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PeerJ Inc.
2014-01-01
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| Online Access: | https://peerj.com/articles/245.pdf |
| _version_ | 1797424192374702080 |
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| author | Bryan G. Maxwell Robert L. Lobato Molly B. Cason Jim K. Wong |
| author_facet | Bryan G. Maxwell Robert L. Lobato Molly B. Cason Jim K. Wong |
| author_sort | Bryan G. Maxwell |
| collection | DOAJ |
| description | Background. Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population.Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality.Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001) cohorts.Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care. |
| first_indexed | 2024-03-09T07:58:42Z |
| format | Article |
| id | doaj.art-85aadfdbb1e146e483222bbfffbef68f |
| institution | Directory Open Access Journal |
| issn | 2167-8359 |
| language | English |
| last_indexed | 2024-03-09T07:58:42Z |
| publishDate | 2014-01-01 |
| publisher | PeerJ Inc. |
| record_format | Article |
| series | PeerJ |
| spelling | doaj.art-85aadfdbb1e146e483222bbfffbef68f2023-12-03T00:50:15ZengPeerJ Inc.PeerJ2167-83592014-01-012e24510.7717/peerj.245245Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate orderBryan G. Maxwell0Robert L. Lobato1Molly B. Cason2Jim K. Wong3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USADepartment of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USADepartment of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USADepartment of Anesthesia, Stanford University School of Medicine, Stanford, CA, USABackground. Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population.Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality.Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001) cohorts.Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care.https://peerj.com/articles/245.pdfDNRDo not resuscitateDo not attempt resuscitationDo-not-resuscitateCardiothoracic surgeryAdvanced directive |
| spellingShingle | Bryan G. Maxwell Robert L. Lobato Molly B. Cason Jim K. Wong Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order PeerJ DNR Do not resuscitate Do not attempt resuscitation Do-not-resuscitate Cardiothoracic surgery Advanced directive |
| title | Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order |
| title_full | Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order |
| title_fullStr | Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order |
| title_full_unstemmed | Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order |
| title_short | Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order |
| title_sort | perioperative morbidity and mortality of cardiothoracic surgery in patients with a do not resuscitate order |
| topic | DNR Do not resuscitate Do not attempt resuscitation Do-not-resuscitate Cardiothoracic surgery Advanced directive |
| url | https://peerj.com/articles/245.pdf |
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