Do-Not-Resuscitate Order Linked to Increased Surgical Mortality

Increased complications, longer hospital stay in patients with do-not-resuscitate orders

MONDAY, April 18 (HealthDay News) -- Surgical patients with do-not-resuscitate (DNR) orders have more complications and a higher mortality rate than non-DNR patients, according to a study published online April 18 in the Archives of Surgery.

Hadiza Kazaure, from the Yale University School of Medicine in New Haven, Conn., and colleagues analysed outcomes of patients with a DNR order, who underwent surgery between 2005 and 2008. Outcomes including occurrence of one or more postoperative complications, reoperation, mortality within 30 days of surgery, time in the operating room, and length of stay in hospital were measured for 4,128 adult DNR patients, and 4,128 age- and procedure-matched non-DNR patients.

The investigators found that DNR patients were significantly more likely than non-DNR patients to have a longer length of stay (36 percent increase), increased rates of complications (31 versus 26.4 percent), and mortality within 30 days (23.1 versus 8.4 percent). Most procedures for DNR patients (nearly 63 percent) were nonemergent, and the mortality rate was 16.6 percent for these procedures. DNR status independently predicted mortality (odds ratio, 2.2), after risk adjustment. Other independent risk factors correlated with mortality in DNR patients were American Society of Anesthesiologists class 3 to 5 and preoperative sepsis.

"Surgical patients with DNR orders have significant comorbidities; many sustain postoperative complications, and nearly one in four die within 30 days of surgery," the authors write.

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