Identifying high‐risk surgical patients: A study of older adults whose code status changed to Do‐Not‐Resuscitate

• Published in: Journal of the American Geriatrics Society (JAGS) 2021-12, Vol.69 (12), p.3445-3456
• Main Authors: Kazaure, Hadiza S., Truong, Tracy, Kuchibhatla, Maragatha, Lagoo‐Deenadayalan, Sandhya, Wren, Sherry M., Johnson, Kimberly S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Databases, Factual; do‐not‐resuscitate; Female; frailty; geriatrics; hospice; Hospice Care - statistics & numerical data; Hospital Mortality; Humans; Inpatients - statistics & numerical data; Male; Odds Ratio; Older people; outcomes; Patients; Perioperative Care - mortality; Quality control; Resuscitation Orders; Retrospective Studies; Risk Assessment; Surgery; Surgical outcomes; Surgical Procedures, Operative - mortality; Time Factors
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.17391

Background There is a paucity of data on older adults (age ≥65 years) undergoing surgery who had an inpatient do‐not‐resuscitate (DNR) order, and the association between timing of DNR order and outcomes. Methods This was a retrospective analysis of 1976 older adults in the American College of Surgeons National Surgical Quality Improvement Program geriatric‐specific database (2014–2018). Patients were stratified by institution of a DNR order during their surgical admission (“new‐DNR” vs. “no‐DNR”), and matched by age (±3 years), frailty score (range: 0–1), and procedure. The main outcome of interest was occurrence of death or hospice transition (DoH) ≤30 postoperative days; this was analyzed using bivariate and multivariable methods. Results One in 36 older adults had a new‐DNR order. After matching, there were 988 new‐DNR and 988 no‐DNR patients. Median age and frailty score were 82 years and 0.2, respectively. Most underwent orthopedic (47.6%), general (37.6%), and vascular procedures (8.4%). Overall DoH rate ≤30 days was 44.4% for new‐DNR versus 4.0% for no‐DNR patients (p