M. A. Hornor1,2, R. A. Rosenthal1,3,5, T. N. Robinson1,4,6 1American College Of Surgeons,Chicago, IL, USA 2Ohio State University Wexner Medical Center,Department Of Surgery,Columbus, OH, USA 3Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA 4University Of Colorado Anschutz Medical Campus,Department Of Surgery,Aurora, CO, USA 5Veterans Affairs Connecticut Health Care System,New Haven, CONNECTICUT, USA 6Veterans Affairs Eastern Colorado Health Care System,Aurora, COLORADO, USA
Introduction: The timing of and risk factors for new DNR orders following surgery in older adults are not well defined. The goal of this study was to investigate the timing of new postoperative DNR orders and to determine if identifiable geriatric syndromes are associated with early postoperative DNR.
Methods: We performed a retrospective cohort study using data from the American College of Surgeons’ (ACS) National Surgical Quality Improvement Project (NSQIP) Geriatric Surgery Pilot Project that collects an additional 20 geriatric and palliative care-specific variables at 26 hospitals. Patients aged ≥ 65 who underwent an inpatient operation were included. The timing of postoperative DNR orders was determined and univariate and multivariate analyses were performed to examine the association between patient factors and early postoperative DNR orders, defined as a new DNR order placed on postoperative day 0-2.
Results: Of the 29,864 patients included in the study, 717 (2.4%) patients had a DNR order placed postoperatively, 329 (1.1%) of which were classified as early. Over half of the patients with early postoperative DNR’s underwent emergency surgery (58.1%). In the adjusted multivariate model, preoperatively identifiable geriatric syndromes were significantly associated with early postoperative DNR [Table 1].
Conclusion: Early postoperative DNR orders are highly associated with preoperative geriatric syndromes and emergency operation status. The consideration of geriatric syndromes such as cognitive and functional status in shared decision making conversations prior to surgery may better inform advance care planning and surgical decision making.
