The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations

Hassan Aziz; Bernardino C Branco; Jonathan Braun; John D Hughes; Kay R Goshima; Magdiel Trinidad-Hernandez; Glenn Hunter; Joseph L Mills Sr

doi:10.1016/j.jvs.2014.11.087

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The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations

Journal article

Open access

Peer reviewed

The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations

Hassan Aziz, Bernardino C Branco, Jonathan Braun, John D Hughes, Kay R Goshima, Magdiel Trinidad-Hernandez, Glenn Hunter and Joseph L Mills Sr

Journal of vascular surgery, Vol.61(6), pp.1538-1542

06/01/2015

DOI: 10.1016/j.jvs.2014.11.087

PMID: 25704406

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Abstract

Do-not-resuscitate (DNR) orders allow patients to communicate their wishes regarding cardiopulmonary resuscitation. Although DNR status may influence physician decision making regarding resuscitation, the effect of DNR status on outcomes of patients undergoing emergency vascular operation remains unknown. The aim of this study was to analyze the effect of DNR status on the outcomes of emergency vascular surgery. 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. Patients were compared according to DNR status. The primary outcome measure was 30-day mortality. During the study period, 16,678 patients underwent emergency vascular operations (10.8% of the total vascular surgery population). Of those, 548 patients (3.3%) had a DNR status. The differences in rates of open or endovascular repair or of intraoperative blood requirement between the two groups were not significant. After adjusting for differences in demographics and clinical data, DNR patients were more likely to have higher rates of graft failure (8.7% vs 2.4%; adjusted P < .01) and failure to wean from mechanical ventilation (14.9 % vs 9.9%; adjusted P < .001). DNR status was associated with a 2.5-fold rise in 30-day mortality (35.0% vs 14.0%; 95% confidence interval, 1.7-2.9; adjusted P < .001). The presence of a DNR order was independently associated with mortality. Patient and family counseling on surgical expectations before emergency vascular operations is warranted because the risks of perioperative events are significantly elevated when a DNR order exists.

United States

Aged

Aged, 80 and over

Databases, Factual

Emergencies

Female

Humans

Male

Middle Aged

Postoperative Complications - mortality

Resuscitation Orders

Retrospective Studies

Risk Assessment

Risk Factors

Time Factors

Treatment Outcome

Vascular Surgical Procedures - adverse effects

Vascular Surgical Procedures - mortality

Details

Title: Subtitle: The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations
Creators: Hassan Aziz - University of Arizona
Bernardino C Branco - University of Arizona
Jonathan Braun - University of Arizona
John D Hughes - University of Arizona
Kay R Goshima - University of Arizona
Magdiel Trinidad-Hernandez - University of Arizona
Glenn Hunter - Southern Arizona VA Health Care System
Joseph L Mills Sr - Banner - University Medical Center Tucson
Resource Type: Journal article
Publication Details: Journal of vascular surgery, Vol.61(6), pp.1538-1542
DOI: 10.1016/j.jvs.2014.11.087
PMID: 25704406
NLM abbreviation: J Vasc Surg
ISSN: 0741-5214
eISSN: 1097-6809
Language: English
Date published: 06/01/2015
Academic Unit: Surgery
Record Identifier: 9984701546602771

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