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Friday, May 27, 2011

DNR orders associated with poor surgical outcomes

DNR (Do-Not-Resuscitate) orders are intended to prevent doctors from going to extraordinary efforts to prolong a failing patient’s life. Nevertheless, patients who have given such orders often do have surgical or other procedures to decrease pain or treat non-life threatening issues. If so, they may wish to temporarily rescind that DNR order before going under the knife. According to a study by Hadiza Kazaure, Sanziana Roman and Julie Sosa from Yale University School of Medicine, having a DNR order significantly decreases your survival rate.

The doctors compared outcomes in 4128 adult DNR patients to those of an equal number of age and procedure-matched non-DNR patients. The DNR group had longer hospital stays, more complications, and most important, more deaths than the non-DNR group. In fact, almost three times as many DNR patients died within 30 days of surgery as non-DNR patients. And these were for the same types of treatments.

It’s not clear why having a DNR order can be so hazardous. One possibility is that patients who have such orders don’t expect to live as long as their cohorts, and this becomes a self-fullfilling prophecy. Alternatively, doctors may subconsciously come to the same conclusion and fight harder to maintain a patient without a DNR order. In any case, the correlation between DNR orders and poor outcomes must be further analyzed.

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