Do-not-resuscitate orders and high-risk pediatric surgery: professional nuisance or medical necessity?

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Publication Date



DOI: 10.1016/j.jss.2017.05.028


Background: There is a paucity of data in the literature regarding end-of-life care and do-not-resuscitate (DNR) status of the pediatric surgical patient, although invasive procedures are frequently performed in very high risk and critically ill children. Despite significant efforts in adult medicine to enhance discussions around end-of-life care, little is known about similar endeavors in the pediatric population.

Methods: A retrospective review of the National Surgical Quality Improvement Program Pediatric database was performed. Patients agedfactors, principal diagnosis, associated conditions, DNR status, and mortality were extracted. Descriptive analysis was performed.

Results: A total of 20,164 patients met the inclusion criteria. Only 36 (0.2%) patients had a signed DNR order before surgical procedure. Of severely ill American Society of Anesthesiologists four patients, only 1% had DNR status. There were no differences in gender, race, ethnicity, or surgical specialty by the presence of a DNR order. Notably, 17.1% of children who died within this period had multiple surgical procedures performed before expiring.

Conclusions: The rate of documented DNR status is extremely low in the high-risk pediatric surgical population undergoing elective surgery, even among severely ill children. Well-informed end-of-life care discussions in a patient-focused approach are essential in the surgical care of children with complex medical conditions and critical illness. Better documentation of DNR discussion will also allow better tracking and benchmarking.

Journal Title

The Journal of surgical research



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MeSH Keywords

Child; Child; Preschool; Female; Humans; Infant; Male; Pediatrics; Resuscitation Orders; Retrospective Studies; Specialties; Surgical


DNR; Do not resuscitate; End-of-life care; Pediatric surgery

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