Abstract
Background
There is a paucity of data in the literature regarding end-of-life care and do-not-resuscitate
(DNR) status of the pediatric surgical patient, although invasive procedures are frequently
performed in very high risk and critically ill children. Despite significant efforts
in adult medicine to enhance discussions around end-of-life care, little is known
about similar endeavors in the pediatric population.
Methods
A retrospective review of the National Surgical Quality Improvement Program Pediatric
database was performed. Patients aged <18 y with American Society of Anesthesiologists
class 3 or greater who underwent elective surgical procedure in 2012-2013 were included.
Demographic factors, principal diagnosis, associated conditions, DNR status, and mortality
were extracted. Descriptive analysis was performed.
Results
A total of 20,164 patients met the inclusion criteria. Only 36 (0.2%) patients had
a signed DNR order before surgical procedure. Of severely ill American Society of
Anesthesiologists four patients, only 1% had DNR status. There were no differences
in gender, race, ethnicity, or surgical specialty by the presence of a DNR order.
Notably, 17.1% of children who died within this period had multiple surgical procedures
performed before expiring.
Conclusions
The rate of documented DNR status is extremely low in the high-risk pediatric surgical
population undergoing elective surgery, even among severely ill children. Well-informed
end-of-life care discussions in a patient-focused approach are essential in the surgical
care of children with complex medical conditions and critical illness. Better documentation
of DNR discussion will also allow better tracking and benchmarking.
Keywords
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Article info
Publication history
Published online: May 11, 2017
Accepted:
May 5,
2017
Received in revised form:
March 23,
2017
Received:
February 10,
2017
Footnotes
Presented as an abstract on February 9, 2017 at the 12th Annual Academic Surgical Congress in Las Vegas, Nevada.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
