We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Surgery and Do-Not-Resuscitate Orders: The Real Risks Defined Comment on “High Mortality in Surgical Patients With Do-Not-Resuscitate Orders”

Kelly L. McCoy, MD; Sally E. Carty, MD
Arch Surg. 2011;146(8):928-929. doi:10.1001/archsurg.2011.177.
Text Size: A A A
Published online


Some of the most unpleasant yet memorable conversations we have as surgeons include those conducted in the wee hours of the night with patients facing terminal illness plus an acute surgical emergency. Often we experience the all-too-familiar ethical squeeze play—why am I the one to conduct this sad, wrenching conversation when the patient has already chosen to let death take its course?

Controversy over perioperative management of DNR orders has been widely recounted, culminating in the position of “required reconsideration” by esteemed groups including the American College of Surgeons and the American Society of Anesthesiologists.1,2 Detailed outcome data for DNR patients who choose surgery have thus far been sparse. Through in-depth interviews, Clemency and Thompson3 found that 83% of patients queried consider surgery despite a preexisting DNR order, while Wenger et al4 showed increased mortality among hospitalized medical patients with a DNR order. In this coherent and very large study based on age- and procedure-matched NSQIP data, Kazaure et al5 now demonstrate similar findings for an exclusively surgical population. They also show that most DNR operations are both nonemergent and major, with a high short-term mortality rate of 17% that is triple the rate for non-DNR patients. They also found that a recent decline in functional status occurs more often in DNR patients, underlining the common involvement of family members in surgical decision making.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence to Support the Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have an Instability of the Shoulder or a Labrum Lesion?