Advance Directive and Do-Not-Resuscitate Status among Advanced Cancer Patients with Acute Care Surgical Consultation

• Published in: The American surgeon Vol. 84; no. 10; p. 1565
• Main Authors: Marcia, Lobsang, Ashman, Zane W, Pillado, Eric B, Kim, Dennis Y, Plurad, David S
• Format: Journal Article
• Language: English
• Published: United States 01-10-2018
• Subjects: Advance Directives - statistics & numerical data; Age Factors; California - epidemiology; Critical Care - statistics & numerical data; Female; Hospital Mortality; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Neoplasm Metastasis; Neoplasms - mortality; Neoplasms - surgery; Patient Preference; Prognosis; Resuscitation Orders; California
• DOI: 10.1177/000313481808401005
• EISSN: 1555-9823

Formal communication of end-of-life preferences is crucial among patients with metastatic cancer. Our objective is to describe the prevalence of advance directives (AD) and do-not-resuscitate (DNR) orders among stage IV cancer patients with acute care surgery consultations, and the associated outcomes. This is a single institution retrospective review over an eight-year period. Two hundred and three patients were identified; mean age was 55.3 ± 11.4 years and 48.8 per cent were male. Fifty (24.6%) patients underwent exploratory surgery. Nineteen (10.6%) patients had another type of surgery. Twenty-one (10.3%) patients had a DNR order, and none had an AD on-admission. Fifty-four (26.6%) patients had a DNR order placed and four (2%) patients completed an AD postadmission. DNR postadmission was associated with the highest mortality at 42.6 per cent compared with 14.3 per cent for DNR on-admission and 1.56 per cent for full-code patients (
< 0.001). Compared with patients that remained full-code and those with DNR on-admission, DNR postadmission was associated with longer length of stay (19.6 days;
< 0.001) and ICU length of stay (7.72 days;
< 0.001). The prevalence of AD and DNR orders among stage IV cancer patients is low. The higher in-hospital mortality of patients with DNR postadmission reflects the use of DNR orders during clinical decline.