title: Further deliberating the relationship between do-not-resuscitate and the increased risk of death.
abstract: Few studies have examined the outcome of do-not-resuscitate (DNR) patients in surgical intensive care units (SICUs). This study deliberated the association between a DNR decision and the increased risk of death methodologically and ethically. This study was conducted in three SICUs. We collected patients' demographic characteristics, clinical characteristics, and the status of death/survival at SICU and hospital discharge. We used Kaplan-Meier survival curves to compare the time from SICU admission to the end of SICU stay for the DNR and non-DNR patients. Differences in the Kaplan-Meier curves were tested using log-rank tests. We also conducted a Cox proportional hazards model to account for the effect of a DNR decision on mortality. We found that having a DNR order was associated with an increased risk of death during the SICU stay (aRR = 2.39, p < 0.01) after adjusting for severity of illness upon SICU admission and other confounding variables. To make the conclusion that a DNR order is causally related to an increased risk of death, or that a DNR order increases the risk of death is absolutely questionable. By clarifying this key point, we expect that the discussion of DNR between healthcare professionals and patients/surrogate decision-makers will not be hampered or delayed.
authors.affiliation: Graduate Institute of Medical Education &Bioethics, National Taiwan University College of Medicine, Taiwan.|Department of Medical Education, National Taiwan University Hospital, Taiwan.
authors.forename: Yen-Yuan
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Surgery, National Taiwan University College of Medicine, Taiwan.|Department of Surgery, National Taiwan University Hospital, Taiwan.
authors.forename: Yih-Sharng
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Graduate Institute of Medical Education &Bioethics, National Taiwan University College of Medicine, Taiwan.|Department of Medical Education, National Taiwan University Hospital, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
authors.forename: Tzong-Shinn
authors.initials: TS
authors.lastname: Chu
authors.affiliation: Graduate Institute of Medical Education &Bioethics, National Taiwan University College of Medicine, Taiwan.
authors.forename: Kuan-Han
authors.initials: KH
authors.lastname: Lin
authors.affiliation: Graduate Institute of Medical Education &Bioethics, National Taiwan University College of Medicine, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
authors.forename: Chau-Chung
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012720:Severity of Illness Index