title: [Quality of dying processes after commencement of the German Living Will Act : Experiences of a surgical intensive care unit].
abstract: BACKGROUND
  There is so far no information on how the third act on amendment of the German guardianship law from 29 July 2009 has affected dying processes of critically ill patients.
  
  
  METHODS
  This retrospective study analyzed the patterns of dying processes in postoperative critically ill patients treated from 2009 to 2012 (period II after the commencement of the German Living Will Act) and 10 years before (period I, 1999-2002). Independent associations were calculated by logistic regression.
  
  
  RESULTS
  In the observation period II (n = 137 dying patients) time until death significantly decreased to 19.3 days (95% CI 14.8-23.8, p = 0.008) vs. 29.2 days (95% CI 23.7-34.6) in period I (n = 163). In period II respect of the patient's will preceded death in 42.3% of the dying patients (period I: 8.6%, p < 0.001). Simultaneously, the frequency of patients with a severe preoperative comorbidity (failure of more than one organ) increased (26.8% of dying patients vs. 5.5% in period I, p = 0.001). The treatment during period II was, in addition to high age and a severe comorbidity, a significant independent predictor for the possibility that respect of the patient's will preceded death (odds ratio 7.42; 95% CI 3.77-14.60).
  
  
  CONCLUSIONS
  Independent of various covariables, treatment after the commencement of the German Living Will Act was associated with a broader and earlier respect of the patient's will, thereby shortening the time until death.
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations- und Gefäßchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Strauss
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations- und Gefäßchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Kuppinger
authors.affiliation: Klinik für Allgemeine, Viszeral-, Transplantations- und Gefäßchirurgie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland. whartl@med.uni-muenchen.de.
authors.forename: W H
authors.initials: WH
authors.lastname: Hartl
mesh_terms: D000368:Aged; D001293:Attitude to Death; D015897:Comorbidity; D003422:Critical Care / Q000592:standards*; D005260:Female; D005858:Germany; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016224:Living Wills / Q000331:legislation & jurisprudence*; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D010166:Palliative Care / Q000331:legislation & jurisprudence*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012189:Retrospective Studies; D013997:Time Factors
keywords: German Living Will Act; Intensive care unit; Process of dying