Provider Perceptions Regarding Cardiopulmonary Resuscitation in Surgical Patients with Frailty

Matthew B Allen; Amanda Reich; Patrick Collins; Karen Chahal; Maria Moustaqim-Barrette; Rachelle E Bernacki; Zara Cooper; Angela M Bader

doi:10.1097/SLA.0000000000006214

Provider Perceptions Regarding Cardiopulmonary Resuscitation in Surgical Patients with Frailty

Ann Surg. 2024 Jan 23. doi: 10.1097/SLA.0000000000006214. Online ahead of print.

Authors

Matthew B Allen¹, Amanda Reich², Patrick Collins¹, Karen Chahal³, Maria Moustaqim-Barrette^{1

4}, Rachelle E Bernacki^{2

5

6}, Zara Cooper^{2

7}, Angela M Bader^{1

2}

Affiliations

¹ Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
³ Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
⁴ Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
⁶ Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁷ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

PMID: 38258581
DOI: 10.1097/SLA.0000000000006214

Abstract

Objective: To characterize the perceptions of surgeons, anesthesiologists, and geriatricians regarding perioperative CPR in surgical patients with frailty.

Summary background data: The population of patients undergoing surgery is growing older and more frail. Despite a growing focus on goal-concordant care, frailty assessment, and debate regarding the appropriateness of cardiopulmonary resuscitation (CPR) in patients with frailty, providers' views regarding frailty and perioperative CPR are unknown.

Methods: We performed qualitative thematic analysis of transcripts from semi-structured interviews of anesthesiologists (8), surgeons (10), and geriatricians (9) who care for high-risk surgical patients at two academic medical centers in Boston, MA. The interview guide elicited clinicians' understanding of frailty, approach to decision-making regarding perioperative CPR, and perceptions of perioperative CPR in frail surgical patients.

Results: We identified 5 themes: perceptions of perioperative CPR in patients with frailty vary by provider specialty; judgments regarding appropriateness of CPR in surgical patients with frailty are typically multifactorial and include patient goals, age, comorbidities, and arrest etiology; resuscitation in patients with frailty is sometimes associated with moral distress; biases such as ableism and ageism may skew clinicians' perceptions of appropriateness of perioperative CPR in patients with frailty; and evidence to guide risk stratification for patients with frailty undergoing perioperative CPR is inadequate.

Conclusions: Anesthesiologists, surgeons, and geriatricians offer different accounts of frailty's relevance to judgments regarding CPR in surgical patients. Divergent views regarding frailty and perioperative CPR may impede efforts to deliver goal-concordant care and suggest a need for research to inform risk stratification, predict patient-centered outcomes, and understand the role of potential biases such as ageism and ableism.