Higher Mortality for Neurosurgery Patients with Pre-Existing DNRs
Neurosurgeons at University of Rochester Medicine observed that patients with pre-existing do-not-resuscitate (DNR) orders receiving cranial neurosurgery tended to have poor outcomes. To see if their clinical observations were reflected in actual data, the neurosurgeons analyzed 30,384 patients who underwent cranial neurosurgery in 2018-2020.1 Some key findings:
- The 2,505 patients with DNR orders received gastrostomy and tracheostomy less compared to patients without DNR orders.
- Patients undergoing cranial neurosurgery with pre-existing DNRs had higher mortality rates compared to non-DNR patients.
- Half of the patients with DNR orders died during their hospitalization.
Given these findings, there are important ethical implications for clinicians evaluating patients with DNR orders who are also eligible for cranial neurosurgery. “It is important to highlight the potential for poor outcomes with surrogate decision-makers and to discuss the possibility of suspension of a DNR in the perioperative setting,” says Benjamin George, MD, MPH, one of the study authors and an assistant professor in the Department of Neurology at University of Rochester Medicine.
It is important for neurosurgeons to consider what the patient would want in each scenario. “Ethicists and clinicians can guide surrogates in making decisions that are in keeping with patient autonomy and self-determination,” offers George.
REFERENCE
- Zhang L, Albert GP, Pieters TA, et al. Association of do-not-resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery. J Clin Neurosci 2023;118:26-33.
Neurosurgeons at University of Rochester Medicine observed that patients with pre-existing do-not-resuscitate (DNR) orders receiving cranial neurosurgery tended to have poor outcomes. To see if their clinical observations were reflected in actual data, the neurosurgeons analyzed 30,384 patients who underwent cranial neurosurgery in 2018-2020.
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