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

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.

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.

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).

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.