Do-not-resuscitate orders and early mortality in hip fracture patients.
factors affecting mortality after hip fracture surgery have been studied extensively. It has been suggested that do-not-resuscitate (DNR) orders are associated with higher mortality in surgical patients due to less aggressive treatment. However, the effect of DNR orders on mortality in hip fracture patients is unknown. The objective of this study was to investigate the effect of DNR orders on early mortality after hip fracture surgery.



all patients undergoing hip fracture surgery between 2004 and 2015 were included in this retrospective study. Patient characteristics such as age, comorbidities and fracture type were collected, as were resuscitation preferences. Multivariable logistic regression analysis was performed to identify independent risk factors for early mortality.



a total of 1,803 patients were analysed, of which 823 (45.6%) had DNR orders. DNR patients were older, more often female, had lower haemoglobin levels and more comorbidities when compared with non-DNR patients. The unadjusted effect of DNR orders on mortality was high (OR: 2.39; P < 0.001). Multivariable analysis demonstrated that increased age, male gender, higher American Society of Anesthesiologists score, low admission haemoglobin, living in an institution, high Charlson Comorbidity Index and delay to surgery were associated with increased early mortality after hip fracture surgery. There was no independent effect of DNR orders on mortality after adjustment for these variables (P = 0.735).



DNR patients have higher mortality rates due to poor health status. Resuscitation preferences on their own are not associated with early mortality after hip fracture surgery.
OLVG Location West-Surgery, Amsterdam, The Netherlands.
Anouk E
AE
Simons
OLVG Location West-Surgery, Amsterdam, The Netherlands.|AMC-Orthopaedic Surgery, Amsterdam, The Netherlands.
Julian
J
Karres
OLVG Location West-Surgery, Amsterdam, The Netherlands.
Leontien M G
LMG
Nijland
OLVG Location West-Surgery, Amsterdam, The Netherlands.
Jan M
JM
Ultee
AMC-Orthopaedic Surgery, Amsterdam, The Netherlands.
Gino M M J
GMMJ
Kerkhoffs
OLVG Location West-Surgery, Amsterdam, The Netherlands.
Bart C
BC
Vrouenraets
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
do-not-resuscitate; hip fracture; mortality; older people