The clinical quandary of counseling the moribund critical care patient—a registry analysis of postsurgical outcomes

Abstract

PurposeTo provide outcomes data to intensivists and surgeons for counseling patients and family members when considering a surgical intervention in a moribund patient. Materials and MethodsRetrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database in moribund patients undergoing general surgical procedures. ResultsOut of 633,262 patients available in the national registry, 2063 (0.3%) were of moribund status. Post-operative mortality was 52.8% for moribund patients. Those who died had higher rates of compromised respiratory, renal and cognitive dysfunction, were older, less independent prior to surgery and had generally longer surgeries. 83% of patients experienced a major complication including mortality and 17 % of patients experienced minor complications. ConclusionThe moribund patient is not as grave as once thought and surgery on these patients may not be futile given the 47% survival rate at 30 days. Postoperative complication rates are high. The data presented provide a meaningful tool for the clinicians in counseling patients and families on the expectations when considering a surgical intervention for moribund patients.