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Effect of Decisions to Withhold Life Support on Prolonged Survival

¹Department of Bioethics, Case Western Reserve University, Cleveland, Ohio ²Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio ³ Departments of Medicine & Community Health Sciences, University of Manitoba, Winnipeg, Manitoba

agarland{at}hsc.mb.ca

Abstract

BackgroundThe effect on long-term mortality of decisions made to withhold life supporting therapies for critically ill patients is unclear. We hypothesized that mortality 60 days after intensive care unit admission is not influenced by a decision to withhold use of life supporting therapies, in the context of otherwise providing all indicated care.

MethodsWe studied 2211 consecutive, initial admissions to the adult, medical intensive care unit of a university-affiliated teaching hospital. To achieve balanced groups for comparing outcomes, we created a multivariable regression model for the probability (propensity score) of having an order initiated in the intensive care unit to withhold life supporting therapies. Each of the 201 patients with such an order was matched to the patient without such an order having the closest propensity score; mortality rates were compared between the matched pairs. Cox survival analysis was performed to extend the main analysis.

ResultsThe matched pairs were well balanced with respect to all of the potentially confounding variables. Sixty days after ICU admission, 50.5% of patients who had an order initiated in the intensive care unit to withhold life support had died, compared to 25.8% of those lacking such orders (risk ratio 2.0, 95% CI 1.5-2.6). Survival analysis indicated that the difference in mortality between the two groups continued to increase for approximately one year.

ConclusionContrary to our hypothesis, decisions made in the intensive care unit to withhold life supporting therapies were associated with increased mortality rate to at least 60 days after ICU admission.

Key Words: Withholding Resuscitation • Do-Not-Resuscitate Orders • Intensive Care Units • Cohort Studies • Long-Term Survivors • Propensity Scores

Related Editorial

Is Withholding Life Support Associated With a Premature Death?: If So, What Does This Mean for ICU Practice?

Helene Starks and J. Randall Curtis
Chest 2008 133: 1298-1300. [Full Text] [PDF]

This article has been cited by other articles:

				H. Starks and J. R. Curtis Is Withholding Life Support Associated With a Premature Death?: If So, What Does This Mean for ICU Practice? Chest, June 1, 2008; 133(6): 1298 - 1300. [Full Text] [PDF]

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