-- Robert Preidt
MONDAY, April 18 (HealthDay News) -- 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
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
"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 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.
The U.S. Agency for Healthcare Research and Quality has more
end-of-life treatment decisions.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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