Impact of admission code status on outcomes of gynecologic oncology patients who died in the hospital

Abstract

<h3>Objectives:</h3> We evaluated the impact of admission code status on time to death, invasive interventions, intensive care unit (ICU) admission, and place of death in the hospital in gynecologic oncology patients. <h3>Methods:</h3> This retrospective chart review included all gynecologic oncology patients who died during an admission to the hospital at a single academic institution between 8/2017 and 4/2020. Code status on admission was documented as either full code or do not attempt resuscitation (DNAR). We defined a terminal diagnosis as a patient who had progression of disease despite two lines of therapy. We evaluated each patient's hospital course including time to death, ICU admission, place of death (oncology floor, palliative care unit, or ICU), and frequency of interventions including cardiopulmonary resuscitation (CPR) and intubation. Statistical analysis was performed using SPSS Statistics v.25. <h3>Results:</h3> A total of 37 patients died as inpatient on the gynecologic oncology service. The most common diagnoses were ovarian (43.2%) and uterine cancer (29.7%). A total of 31 patients were full code and 6 were DNAR on admission. 22 patients were admitted to the ICU, 21 were intubated, and 8 had CPR. The average time of death was 3.5 days in the DNAR group compared to 7.7 days in the full code group. The average time to change the code status from full code to DNAR was 4.9 days. 22 patients had recurrent disease and 20 of these patients had terminal disease. Of the 20 terminal patients, 6 were DNAR and the average time to death was 3.6 days (range, 1-8); 14 were full code and the average time to death was 7.0 days (range, 2-21). Of the 14 terminal patients who were full code, 6 were intubated, and 4 underwent CPR. A total of nine terminal patients died on the oncology floor, 8 died in the ICU, and 3 in the palliative care unit. <h3>Conclusions:</h3> Terminal gynecologic oncology patients who are full code and die in an inpatient setting have a longer time to death than patients who are DNAR on admission. These patients frequently have invasive interventions such as ICU admission, CPR, and intubation. Appropriate counseling on goals of care prior to admission or at admission may prevent futile interventions in terminal gynecologic oncology patients.