The Impact of Do-Not-Resuscitate Orders on Outcomes of Urological Surgeries.

Abstract

Introduction: This study aims to investigate intraoperative and 30-day postoperative outcomes in patients with do-not-resuscitate orders (DNR) undergoing urological surgery.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) were used to identify urology patients with documented DNR orders. Controls were propensity score-matched based on sex, age, BMI, smoking status, functional status, American Society of Anesthesiologists classification, surgery type, wound class, and comorbidities.

Results: We identified 245 DNR patients and 234 matched controls. Most DNR patients were male (75%), White (69%), hypertensive (75%), and underwent minor surgeries (57%). Baseline characteristics showed no significant differences between DNR and non-DNR cohorts. Compared with non-DNR, DNR patients had higher mortality rates (14% vs 6%, P = .003), especially in minor surgeries (6.9% vs 2.6%, P = .016), shorter time from operation to death (14 days, IQR 4-22 vs 18 days, IQR 11-21, P = .4), longer median hospital stay (6 days, IQR 1-14 vs 1 day, IQR 0-6, P < .001), and extended time to discharge (3 days, IQR 1-7 vs 1 day, IQR 0-4; P < .001). DNR patients also had more minor postoperative complications (12% vs 6%, P = .025), most notably UTIs (10% vs 4.3%, P = .013).

Conclusions: DNR patients undergoing urological surgery face higher mortality, longer hospital stays, and more minor complications. Clinicians should weigh surgical benefits against increased mortality risk, considering the lower threshold for withdrawing life support and potential failure or delays in complication management.