H. Aziz1, B. C. Branco1, J. Braun1, M. Trinidad-Hernandez1, J. Hughes1, J. L. Mills1, J. L. Mills1 1University Of Arizona,Tucson, AZ, USA
Introduction
Do-not-resuscitate (DNR) orders allow patients to communicate their wishes regarding cardiopulmonary resuscitation. Although DNR status may influence physician decision-making beyond resuscitation, the impact of DNR status on the outcomes of patients undergoing emergent vascular operations remains unknown. The aim of this study was to analyze the outcomes of DNR patients undergoing emergency vascular surgery.
Methods
The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency vascular surgical interventions between 2005 and 2010. Demographics, clinical data, and outcomes were extracted. Patient outcomes were compared according to DNR status and the primary outcome was mortality.
Results
Over the study period, a total of 16,678 patients underwent emergency vascular operations (10.8% of the total vascular surgery population). Of those, 548 (3.3%) patients had a preoperative DNR status. There were no significant differences in rates of open or endovascular repair, or intraoperative blood requirements between the two groups. After adjusting for differences in demographics, and clinical data, DNR patients were more likely to have higher graft failure rates (8.7 % vs 2.4%; Adj. P < 0.01), and failure to wean from mechanical ventilation ( 14.9 % vs. 9.9%. Adj. P < 0.001). DNR status was associated with a 2.5 fold rise in 30- day mortality (35% vs. 14%; 95% CI: 1.7-2.9, Adj. P<0.001).
Conclusion
The presence of DNR order was independently associated with mortality. Patient and family counseling on surgical expectations prior to emergent operations is warranted as perioperative risks are significantly elevated when a DNR order exists.