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

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background 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. 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. Patients were compared according to DNR status. The primary outcome measure was 30-day mortality. Results 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). Conclusions 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.

Original languageEnglish (US)
Pages (from-to)1538-1542
Number of pages5
JournalJournal of Vascular Surgery
Volume61
Issue number6
DOIs
StatePublished - Jun 1 2015

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Blood Vessels
Emergencies
Resuscitation Orders
Mortality
Demography
Cardiopulmonary Resuscitation
Quality Improvement
Artificial Respiration
Resuscitation
Counseling
Decision Making
Outcome Assessment (Health Care)
Databases
Confidence Intervals
Physicians
Transplants
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations. / Aziz, Hassan; Branco, Bernardino C.; Braun, Jonathan; Hughes, John D; Goshima, Kay R.; Trinidad Hernandez, Magdiel -; Hunter, Glenn; Mills, Joseph L.

In: Journal of Vascular Surgery, Vol. 61, No. 6, 01.06.2015, p. 1538-1542.

Research output: Contribution to journalArticle

Aziz, Hassan ; Branco, Bernardino C. ; Braun, Jonathan ; Hughes, John D ; Goshima, Kay R. ; Trinidad Hernandez, Magdiel - ; Hunter, Glenn ; Mills, Joseph L. / The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 6. pp. 1538-1542.
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abstract = "Background 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. 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. Patients were compared according to DNR status. The primary outcome measure was 30-day mortality. Results 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). Conclusions 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.",
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N2 - Background 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. 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. Patients were compared according to DNR status. The primary outcome measure was 30-day mortality. Results 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). Conclusions 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.

AB - Background 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. 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. Patients were compared according to DNR status. The primary outcome measure was 30-day mortality. Results 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). Conclusions 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.

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