Do Not Resuscitate status as an independent risk factor for patients undergoing surgery for hip fracture

作     者：Ethan Y Brovman Andrew J Pisansky Anair Beverly Angela M Bader Richard D Urman 

作者机构：Department of AnesthesiologyPerioperative and Pain MedicineBrigham and Women’s Hospital Center for Perioperative ResearchBrigham and Women’s Hospital 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2017年第8卷第12期

页      面：902-912页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：Center for Perioperative Research Harvard Medical School, HMS 

主　　题：Do Not Resuscitate Consent Perioperative Outcomes Mortality Hip fracture 

摘      要：AIM To determine morbidity and mortality in this specific patient group and also to assess for any independent associations between Do Not Resuscitate(DNR) status and increased post-operative morbidity and *** We conducted a propensity score matched retrospective analysis using de-identified data from the American College of Surgeons National Surgical Quality Improvement Project(ACS NSQIP) for all patients undergoing hip fracture surgery over a 7 year period in hospitals across the United States enrolled in ACS NSQIP with and without Do Not Resuscitate Status. We measured patient demographics including DNR status, co-morbidities, frailty and functional baseline, surgical and anaestheticprocedure data, post-operative morbidity/complications, length of stay, discharge destination and *** Of 9218 patients meeting the inclusion criteria, 13.6% had a DNR status, 86.4% did not. Mortality was higher in the DNR status compared to the non-DNR group, at 15.3% vs 8.1% and propensity score matched multivariable analysis demonstrated that DNR status was independently associated with mortality(OR = 2.04, 95%CI: 1.46-2.86, P 0.001). Additionally, analysis of the propensity score matched cohort demonstrated that DNR status was associated with a significant, but very small increased likelihood of post-operative complications(0.53 vs 0.43 complications per episode; OR = 1.21; 95%CI: 1.04-1.41, P = 0.004). Cardiopulmonary resuscitation and unplanned reintubation were significantly less likely in patients with DNR *** Whilst DNR status patients had higher rates of postoperative complications and mortality, DNR status itself was not otherwise associated with increased morbidity. DNR status appears to increase 30-d mortality via ceilings of care in keeping with a DNR status, including withholding reintubation and cardiopulmonary resuscitation.