Identifying Factors Associated With Code Status Changes After Emergency General Surgery

Area of Science:

• Emergency Medicine
• Surgical Critical Care
• Patient Outcomes

Background:

• Surgical emergencies necessitate rapid decision-making.
• Aligning operative interventions with patient values requires understanding goals of care.
• Code status change (CSC) can indicate a shift in patient goals post-surgery.

Purpose of the Study:

• To identify patient factors associated with acute changes in goals of care.
• To use postoperative code status change (CSC) as a proxy for shifts in patient goals.
• To inform preoperative discussions for patients undergoing urgent surgery.

Main Methods:

• Retrospective analysis of single-institution data.
• Patients undergoing urgent laparotomy were analyzed.
• Stratification based on postoperative CSC and statistical analyses were performed.

Main Results:

• 13.8% of 484 patients experienced a postoperative CSC.
• Older age, interfacility transfer, higher comorbidity index, and elevated quick SOFA scores were associated with CSC.
• Anemia and active cancer also increased the odds of CSC.

Conclusions:

• A subset of emergency surgery patients experience postoperative CSC, transitioning to comfort care.
• Identifying patients at higher risk for CSC is vital.
• Pausing clinical momentum may ensure goal-concordant care in these high-risk patients.