title: The influence of do-not-resuscitate status on the outcomes of patients undergoing emergency vascular operations.
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.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Ariz. Electronic address: haziz@surgery.arizona.edu.
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Ariz.
authors.forename: Bernardino C
authors.initials: BC
authors.lastname: Branco
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Braun
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
authors.forename: John D
authors.initials: JD
authors.lastname: Hughes
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
authors.forename: Kay R
authors.initials: KR
authors.lastname: Goshima
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
authors.forename: Magdiel
authors.initials: M
authors.lastname: Trinidad-Hernandez
authors.affiliation: Division of Vascular Surgery, Southern Arizona Veteran Affairs Health Care System, Tucson, Ariz.
authors.forename: Glenn
authors.initials: G
authors.lastname: Hunter
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Medical Center, Tucson, Ariz.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mills
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality*