Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery

BACKGROUNDPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission.METHODSWe performed a retrospective cohort study usin...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Journal of clinical neuroscience 2023-12, Vol.118, p.26-33
Hauptverfasser: Zhang, Lan, Albert, George P., Pieters, Thomas A., McHugh, Daryl C., Asemota, Anthony O., Roberts, Debra E., Hwang, David Y., Bender, Matthew T., George, Benjamin P.
Format: Artikel
Sprache:eng
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 33
container_issue
container_start_page 26
container_title Journal of clinical neuroscience
container_volume 118
creator Zhang, Lan
Albert, George P.
Pieters, Thomas A.
McHugh, Daryl C.
Asemota, Anthony O.
Roberts, Debra E.
Hwang, David Y.
Bender, Matthew T.
George, Benjamin P.
description BACKGROUNDPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission.METHODSWe performed a retrospective cohort study using the California State Inpatient Database, January 2018 to December 2020. We used International Classification of Diseases, 10th Revision (ICD-10) codes to identify emergent hospitalizations with principal diagnosis of brain injury, including traumatic brain injury [TBI], ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], or malignant brain tumor [mBT]. We used procedure and Diagnosis Related Group codes to identify cranial neurosurgery. Patients with DNR were one-to-one matched to non-DNR controls based on diagnosis (exact matching), age, sex, Elixhauser comorbidity index, and organ failure (coarsened matching). The primary outcome was inpatient mortality.RESULTSIn California, 30,384 patients underwent cranial neurosurgery, 2018-2020 (n = 3,112, 10% DNR). DNR patients were older, more often female, more often White, with greater comorbidity and organ system dysfunction. There were 2,505 patients with DNR orders 1:1 matched to controls. Patients with DNR had greater inpatient mortality (56% vs. 23%, p < 0.001; Hazard Ratio 3.11, 95% CI 2.50-3.86), received tracheostomy (Odds Ratio [OR] 0.37, 95% CI 0.24-0.57) and gastrostomy less (OR 0.48, 95% CI 0.39-0.58) compared to controls. Multivariable analysis of the unmatched cohort demonstrated similar results.CONCLUSIONPatients undergoing cranial neurosurgery with early or pre-existing DNR have high inpatient mortality compared to clinically similar non-DNR patients; 1 in 2 died during their hospitalization.
doi_str_mv 10.1016/j.jocn.2023.10.006
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2880100290</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2880100290</sourcerecordid><originalsourceid>FETCH-LOGICAL-c231t-e15c9881b8cdb9641bc98aa3abaf6d51c5ceed2e0f851c35e0eef03dcd220b623</originalsourceid><addsrcrecordid>eNotkE1LxDAURYMoOI7-AVdZuml9SaYxXQ7jJwwKouuSpq9jSpt0knYx_94UXT3u4XB5XEJuGeQMmLzv8s4bl3PgIoEcQJ6RFSsEz7gsxDlZQSkfskJJdUmuYuwAoNwIWJHjNkZvrJ6sd9S39NFn737KPjHO0dhJT0h9aDBEql1Drct-fBwT7-ngQzp2OlE9eHegY-pAN0U6u-QfvE3MBO1sch3Owcc5HDCcrslFq_uIN_93Tb6fn752r9n-4-Vtt91nhgs2ZcgKUyrFamWaupQbVqeotdC1bmVTMFMYxIYjtCoFUSAgtiAa03AOteRiTe7-esfgjzPGqRpsNNj32qGfY8WVAgbAS0gq_1NN-jIGbKsx2EGHU8WgWvatumrZt1r2XVjaV_wCinlzbg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2880100290</pqid></control><display><type>article</type><title>Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery</title><source>Access via ScienceDirect (Elsevier)</source><creator>Zhang, Lan ; Albert, George P. ; Pieters, Thomas A. ; McHugh, Daryl C. ; Asemota, Anthony O. ; Roberts, Debra E. ; Hwang, David Y. ; Bender, Matthew T. ; George, Benjamin P.</creator><creatorcontrib>Zhang, Lan ; Albert, George P. ; Pieters, Thomas A. ; McHugh, Daryl C. ; Asemota, Anthony O. ; Roberts, Debra E. ; Hwang, David Y. ; Bender, Matthew T. ; George, Benjamin P.</creatorcontrib><description>BACKGROUNDPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission.METHODSWe performed a retrospective cohort study using the California State Inpatient Database, January 2018 to December 2020. We used International Classification of Diseases, 10th Revision (ICD-10) codes to identify emergent hospitalizations with principal diagnosis of brain injury, including traumatic brain injury [TBI], ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], or malignant brain tumor [mBT]. We used procedure and Diagnosis Related Group codes to identify cranial neurosurgery. Patients with DNR were one-to-one matched to non-DNR controls based on diagnosis (exact matching), age, sex, Elixhauser comorbidity index, and organ failure (coarsened matching). The primary outcome was inpatient mortality.RESULTSIn California, 30,384 patients underwent cranial neurosurgery, 2018-2020 (n = 3,112, 10% DNR). DNR patients were older, more often female, more often White, with greater comorbidity and organ system dysfunction. There were 2,505 patients with DNR orders 1:1 matched to controls. Patients with DNR had greater inpatient mortality (56% vs. 23%, p &lt; 0.001; Hazard Ratio 3.11, 95% CI 2.50-3.86), received tracheostomy (Odds Ratio [OR] 0.37, 95% CI 0.24-0.57) and gastrostomy less (OR 0.48, 95% CI 0.39-0.58) compared to controls. Multivariable analysis of the unmatched cohort demonstrated similar results.CONCLUSIONPatients undergoing cranial neurosurgery with early or pre-existing DNR have high inpatient mortality compared to clinically similar non-DNR patients; 1 in 2 died during their hospitalization.</description><identifier>ISSN: 0967-5868</identifier><identifier>EISSN: 1532-2653</identifier><identifier>DOI: 10.1016/j.jocn.2023.10.006</identifier><language>eng</language><ispartof>Journal of clinical neuroscience, 2023-12, Vol.118, p.26-33</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c231t-e15c9881b8cdb9641bc98aa3abaf6d51c5ceed2e0f851c35e0eef03dcd220b623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Zhang, Lan</creatorcontrib><creatorcontrib>Albert, George P.</creatorcontrib><creatorcontrib>Pieters, Thomas A.</creatorcontrib><creatorcontrib>McHugh, Daryl C.</creatorcontrib><creatorcontrib>Asemota, Anthony O.</creatorcontrib><creatorcontrib>Roberts, Debra E.</creatorcontrib><creatorcontrib>Hwang, David Y.</creatorcontrib><creatorcontrib>Bender, Matthew T.</creatorcontrib><creatorcontrib>George, Benjamin P.</creatorcontrib><title>Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery</title><title>Journal of clinical neuroscience</title><description>BACKGROUNDPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission.METHODSWe performed a retrospective cohort study using the California State Inpatient Database, January 2018 to December 2020. We used International Classification of Diseases, 10th Revision (ICD-10) codes to identify emergent hospitalizations with principal diagnosis of brain injury, including traumatic brain injury [TBI], ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], or malignant brain tumor [mBT]. We used procedure and Diagnosis Related Group codes to identify cranial neurosurgery. Patients with DNR were one-to-one matched to non-DNR controls based on diagnosis (exact matching), age, sex, Elixhauser comorbidity index, and organ failure (coarsened matching). The primary outcome was inpatient mortality.RESULTSIn California, 30,384 patients underwent cranial neurosurgery, 2018-2020 (n = 3,112, 10% DNR). DNR patients were older, more often female, more often White, with greater comorbidity and organ system dysfunction. There were 2,505 patients with DNR orders 1:1 matched to controls. Patients with DNR had greater inpatient mortality (56% vs. 23%, p &lt; 0.001; Hazard Ratio 3.11, 95% CI 2.50-3.86), received tracheostomy (Odds Ratio [OR] 0.37, 95% CI 0.24-0.57) and gastrostomy less (OR 0.48, 95% CI 0.39-0.58) compared to controls. Multivariable analysis of the unmatched cohort demonstrated similar results.CONCLUSIONPatients undergoing cranial neurosurgery with early or pre-existing DNR have high inpatient mortality compared to clinically similar non-DNR patients; 1 in 2 died during their hospitalization.</description><issn>0967-5868</issn><issn>1532-2653</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNotkE1LxDAURYMoOI7-AVdZuml9SaYxXQ7jJwwKouuSpq9jSpt0knYx_94UXT3u4XB5XEJuGeQMmLzv8s4bl3PgIoEcQJ6RFSsEz7gsxDlZQSkfskJJdUmuYuwAoNwIWJHjNkZvrJ6sd9S39NFn737KPjHO0dhJT0h9aDBEql1Drct-fBwT7-ngQzp2OlE9eHegY-pAN0U6u-QfvE3MBO1sch3Owcc5HDCcrslFq_uIN_93Tb6fn752r9n-4-Vtt91nhgs2ZcgKUyrFamWaupQbVqeotdC1bmVTMFMYxIYjtCoFUSAgtiAa03AOteRiTe7-esfgjzPGqRpsNNj32qGfY8WVAgbAS0gq_1NN-jIGbKsx2EGHU8WgWvatumrZt1r2XVjaV_wCinlzbg</recordid><startdate>202312</startdate><enddate>202312</enddate><creator>Zhang, Lan</creator><creator>Albert, George P.</creator><creator>Pieters, Thomas A.</creator><creator>McHugh, Daryl C.</creator><creator>Asemota, Anthony O.</creator><creator>Roberts, Debra E.</creator><creator>Hwang, David Y.</creator><creator>Bender, Matthew T.</creator><creator>George, Benjamin P.</creator><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202312</creationdate><title>Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery</title><author>Zhang, Lan ; Albert, George P. ; Pieters, Thomas A. ; McHugh, Daryl C. ; Asemota, Anthony O. ; Roberts, Debra E. ; Hwang, David Y. ; Bender, Matthew T. ; George, Benjamin P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c231t-e15c9881b8cdb9641bc98aa3abaf6d51c5ceed2e0f851c35e0eef03dcd220b623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Lan</creatorcontrib><creatorcontrib>Albert, George P.</creatorcontrib><creatorcontrib>Pieters, Thomas A.</creatorcontrib><creatorcontrib>McHugh, Daryl C.</creatorcontrib><creatorcontrib>Asemota, Anthony O.</creatorcontrib><creatorcontrib>Roberts, Debra E.</creatorcontrib><creatorcontrib>Hwang, David Y.</creatorcontrib><creatorcontrib>Bender, Matthew T.</creatorcontrib><creatorcontrib>George, Benjamin P.</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Lan</au><au>Albert, George P.</au><au>Pieters, Thomas A.</au><au>McHugh, Daryl C.</au><au>Asemota, Anthony O.</au><au>Roberts, Debra E.</au><au>Hwang, David Y.</au><au>Bender, Matthew T.</au><au>George, Benjamin P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery</atitle><jtitle>Journal of clinical neuroscience</jtitle><date>2023-12</date><risdate>2023</risdate><volume>118</volume><spage>26</spage><epage>33</epage><pages>26-33</pages><issn>0967-5868</issn><eissn>1532-2653</eissn><abstract>BACKGROUNDPrevious studies identified pre-existing DNR orders as a predictor of mortality after surgery. We sought to evaluate mortality of patients receiving cranial neurosurgery with DNR orders placed at the time of, or within 24 h of admission.METHODSWe performed a retrospective cohort study using the California State Inpatient Database, January 2018 to December 2020. We used International Classification of Diseases, 10th Revision (ICD-10) codes to identify emergent hospitalizations with principal diagnosis of brain injury, including traumatic brain injury [TBI], ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], or malignant brain tumor [mBT]. We used procedure and Diagnosis Related Group codes to identify cranial neurosurgery. Patients with DNR were one-to-one matched to non-DNR controls based on diagnosis (exact matching), age, sex, Elixhauser comorbidity index, and organ failure (coarsened matching). The primary outcome was inpatient mortality.RESULTSIn California, 30,384 patients underwent cranial neurosurgery, 2018-2020 (n = 3,112, 10% DNR). DNR patients were older, more often female, more often White, with greater comorbidity and organ system dysfunction. There were 2,505 patients with DNR orders 1:1 matched to controls. Patients with DNR had greater inpatient mortality (56% vs. 23%, p &lt; 0.001; Hazard Ratio 3.11, 95% CI 2.50-3.86), received tracheostomy (Odds Ratio [OR] 0.37, 95% CI 0.24-0.57) and gastrostomy less (OR 0.48, 95% CI 0.39-0.58) compared to controls. Multivariable analysis of the unmatched cohort demonstrated similar results.CONCLUSIONPatients undergoing cranial neurosurgery with early or pre-existing DNR have high inpatient mortality compared to clinically similar non-DNR patients; 1 in 2 died during their hospitalization.</abstract><doi>10.1016/j.jocn.2023.10.006</doi><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0967-5868
ispartof Journal of clinical neuroscience, 2023-12, Vol.118, p.26-33
issn 0967-5868
1532-2653
language eng
recordid cdi_proquest_miscellaneous_2880100290
source Access via ScienceDirect (Elsevier)
title Association of Do-Not-Resuscitate orders and in-hospital mortality among patients undergoing cranial neurosurgery
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T03%3A49%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20of%20Do-Not-Resuscitate%20orders%20and%20in-hospital%20mortality%20among%20patients%20undergoing%20cranial%20neurosurgery&rft.jtitle=Journal%20of%20clinical%20neuroscience&rft.au=Zhang,%20Lan&rft.date=2023-12&rft.volume=118&rft.spage=26&rft.epage=33&rft.pages=26-33&rft.issn=0967-5868&rft.eissn=1532-2653&rft_id=info:doi/10.1016/j.jocn.2023.10.006&rft_dat=%3Cproquest_cross%3E2880100290%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2880100290&rft_id=info:pmid/&rfr_iscdi=true