• Age and ageing · Nov 2017

    Do-not-resuscitate orders and early mortality in hip fracture patients.

    • Anouk E Simons, Julian Karres, Leontien M G Nijland, Jan M Ultee, Kerkhoffs Gino M M J GMMJ AMC-Orthopaedic Surgery, Amsterdam, The Netherlands., and Bart C Vrouenraets.
    • OLVG Location West-Surgery, Amsterdam, The Netherlands.
    • Age Ageing. 2017 Nov 1; 46 (6): 946-951.

    Backgroundfactors affecting mortality after hip fracture surgery have been studied extensively. It has been suggested that do-not-resuscitate (DNR) orders are associated with higher mortality in surgical patients due to less aggressive treatment. However, the effect of DNR orders on mortality in hip fracture patients is unknown. The objective of this study was to investigate the effect of DNR orders on early mortality after hip fracture surgery.Methodsall patients undergoing hip fracture surgery between 2004 and 2015 were included in this retrospective study. Patient characteristics such as age, comorbidities and fracture type were collected, as were resuscitation preferences. Multivariable logistic regression analysis was performed to identify independent risk factors for early mortality.Resultsa total of 1,803 patients were analysed, of which 823 (45.6%) had DNR orders. DNR patients were older, more often female, had lower haemoglobin levels and more comorbidities when compared with non-DNR patients. The unadjusted effect of DNR orders on mortality was high (OR: 2.39; P < 0.001). Multivariable analysis demonstrated that increased age, male gender, higher American Society of Anesthesiologists score, low admission haemoglobin, living in an institution, high Charlson Comorbidity Index and delay to surgery were associated with increased early mortality after hip fracture surgery. There was no independent effect of DNR orders on mortality after adjustment for these variables (P = 0.735).ConclusionsDNR patients have higher mortality rates due to poor health status. Resuscitation preferences on their own are not associated with early mortality after hip fracture surgery.© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For Permissions, please email: journals.permissions@oup.com

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