Current practice and awareness of perioperative do-not-attempt-resuscitation orders: a single-center retrospective survey and complete questionnaire survey

Purpose: We investigated whether patients who have been issued a do-not-attempt-resuscitation order (DNAR) preoperatively (hereafter, DNAR patients) are informed of the DNAR code change when they undergo anesthesia. We also conducted a survey of the awareness of medical staff regarding perioperative DNARs, and investigated the current situation at a single-center in Japan.

Methods: For DNAR patients managed by anesthesiologists from January 2019 to September 2022, we retrospectively investigated whether the patient was informed of the DNAR code change or the DNAR was automatically suspended without explanation. Next, in July 2023, a questionnaire survey on perioperative DNARs was conducted among all medical staff at our center.

Results: Among the 4,164 cases managed by anesthesiologists during the study period, 100 DNAR patients (2.4%) were identified. Of these, 27 patients received an explanation about the DNAR code change before surgery. Multivariate analysis showed that female patients (odds ratio [OR] 5.3, 95% confidence interval [CI] 3.8-6.7; p = 0.023) and patients with low Barthel Index (OR 0.98, 95% CI 0.96-0.99; p = 0.010) tended to receive explanations about DNAR code changes. In the questionnaire survey, 25% of the 1,051 respondents answered that DNAR code changes should be explained to patients before surgery.

Conclusion: In clinical practice, 27% of DNAR patients were informed of DNARs code change before surgery. Perioperative advance care planning should be further promoted in clinical practice by creating guidelines and training programs regarding perioperative DNARs.