Perioperative Code Status Discussions in Surgical Practice: Results from a National Survey Among Swiss Surgeons

Area of Science:

• Medical Practice
• Surgical Care
• Patient Communication

Background:

• Code status discussions (CSDs) are vital for perioperative care.
• Guidelines recommend CSDs for all surgical patients, yet implementation is inconsistent.
• Barriers to CSD implementation include institutional and clinical factors.

Purpose of the Study:

• To assess current practices and attitudes of Swiss general surgeons regarding perioperative code status discussions.
• To evaluate the management of surgical patients with do-not-resuscitate (DNR) orders.

Main Methods:

• A national web-based survey was conducted among general surgeons in Switzerland.
• The study assessed the proportion of surgeons routinely performing CSDs in patients with American Society of Anesthesiologists (ASA) classifications 3-4.
• Secondary outcomes included CSDs in ASA 1-2 and ASA 5 patients, therapy limitation discussions, and DNR order management.

Main Results:

• 71.2% of surgeons routinely conducted CSDs with ASA 3-4 patients.
• Routine CSDs were associated with prior resuscitation experience, advance directive assessment, and institutional training.
• 50% of surgeons discussed code status with patients having DNR orders, correlating with fewer conflicts and better interdisciplinary collaboration.

Conclusions:

• A majority of surgeons discuss code status with higher-risk patients and support respecting DNR orders.
• Limited institutional training in CSDs was identified as a significant gap.
• Enhancing perioperative communication quality necessitates structured education, guideline implementation, and interdisciplinary teamwork.