High Mortality in Surgical Patients With Do-Not-Resuscitate Orders

American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, “full code” is the default option irrespective of clinical circumstances and patient preferences. It is time to revisit this approach based on (1) increasing understanding of the power of default options in healthcare settings, (2) changing demographics and growing evidence suggesting that an expanding subset of patients is vulnerable to poor outcomes after perioperative cardiopulmonary resuscitation (CPR), and (3) recommendations from multiple societies promoting risk assessment and goal-concordant care in older surgical patients. The authors reconsider current guidelines in the context of these developments and advocate for an expanded approach to decision-making regarding CPR, which involves identifying high-risk elderly patients and eliciting their preferences regarding CPR irrespective of existing or presumed code status.

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High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia

PLoS ONE ◽

10.1371/journal.pone.0159501 ◽

2016 ◽

Vol 11 (7) ◽

pp. e0159501 ◽

Cited By ~ 6

Author(s):

Chun-Ta Huang ◽

Yu-Chung Chuang ◽

Yi-Ju Tsai ◽

Wen-Je Ko ◽

Chong-Jen Yu

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

East Asia ◽

High Mortality ◽

Do Not Resuscitate ◽

Do Not Resuscitate Orders ◽

Sepsis And Septic Shock

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Surrogate Consent for Surgery Forecasts Early Do-Not-Resuscitate Orders and High Mortality

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2015.07.191 ◽

2015 ◽

Vol 221 (4) ◽

pp. S84

Author(s):

Sanjay Mohanty ◽

Thomas N. Robinson ◽

Zara Cooper ◽

Margaret L. Schwarze ◽

Karl Y. Bilimoria ◽

...

Keyword(s):

High Mortality ◽

Do Not Resuscitate ◽

Do Not Resuscitate Orders ◽

Surrogate Consent

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Pre-existing do-not-resuscitate orders are not associated with increased postoperative morbidity at 30 days in surgical patients*

Critical Care Medicine ◽

10.1097/ccm.0b013e31820eb4fc ◽

2011 ◽

Vol 39 (5) ◽

pp. 1036-1041 ◽

Cited By ~ 19

Author(s):

Leif Saager ◽

Andrea Kurz ◽

Anupa Deogaonkar ◽

Jing You ◽

Edward J. Mascha ◽

...

Keyword(s):

Postoperative Morbidity ◽

Surgical Patients ◽

Do Not Resuscitate ◽

Do Not Resuscitate Orders

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Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

10.2310/vasc.2187 ◽

2015 ◽

Author(s):

Margaret L. Schwarze

Keyword(s):

Health Care ◽

Advance Directives ◽

Living Will ◽

Surgical Patients ◽

Living Wills ◽

Do Not Resuscitate ◽

Power Of Attorney ◽

Do Not Resuscitate Orders ◽

Surrogate Decision ◽

Binding Mechanisms

Documentation of future wishes for life-supporting therapy includes living wills, do not resuscitate orders, and designations of a durable power of attorney for health care. All are legally binding mechanisms. Because surgeons may need to refer to these documents, this chapter discusses the use of advance directives and living wills in surgical patients, the use of do not resuscitate orders in the operating room, and the activation and use of power of attorney and subsequent surrogate decision-making. A figure shows a living will designating conditions for resuscitation. This review contains 42 references.

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