For CPR or Not-For-CPR? Demographic Factors Predict Resuscitation Order Documentation and CPR Status in General Surgery Patients.

Abstract

Background: To improve healthcare equity, this study aimed to determine which demographic factors are associated with resuscitation order documentation and not-for-cardiopulmonary resuscitation (CPR) status in general surgery patients.

Methods: A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Logistic regression evaluated associations between demographic factors, and resuscitation order documentation and not-for-CPR status.

Results: 12 846 patients were included, with 1853 (14.4%) having documented resuscitation orders. Of those with resuscitation orders, 964 (52.0%) were for CPR in cardiac arrest. Increased age (OR 1.05, 95% CI 1.04-1.05, p < 0.001), increased Charlson comorbidity index (OR 1.15, 95% CI 1.13-1.17, p < 0.001) and lower socioeconomic status (OR 0.997, 95% CI 0.995-0.999, p = 0.008) were associated with a greater likelihood of having a resuscitation order documented. Female sex (OR 0.76, 95% CI 0.60-0.95, p = 0.016), increased age (OR 0.92, 95% CI 0.91-0.93, p < 0.001), and Charlson comorbidity index (OR 0.89, 95% CI 0.86-0.92, p < 0.001) were significantly associated with being not-for-CPR. Having a resuscitation order documented (OR 18.0, 95% CI 10.9-29.7, p < 0.001) and being not-for-CPR (OR 20.7, 95% CI 10.0-42.8, p < 0.001) were significantly associated with increased in-hospital mortality. Having a specified religion was associated with an OR of 1.29 for being for CPR (95% CI 1.02-1.62, p = 0.032).

Conclusion: This study demonstrated that multiple demographic factors predict resuscitation order documentation and content in general surgery patients, including which patients are not-for-CPR. These findings may improve equity in care for general surgery patients in clinical deterioration and end-of-life situations.