Decision-Making Regarding CPR in Older Surgical Patients: Time for a New Approach

ASA guidelines for perioperative management of do-not-resuscitate (DNR) orders recommend that we revisit existing DNR orders prior to surgery and modify them as needed to align with patient preferences and clinical circumstances (asamonitor.pub/3lq2jgi). This “revisit and revise” or “required reconsideration” approach is a clear step beyond “automatic reversal” of DNR orders in that it preserves patients' rights to self-determination and promotes patient-centered decision-making (Anesthesiology 1991;74:606-8). These guidelines are silent, however, regarding the vast majority of patients who present for surgery without DNR orders in place, and it is generally assumed that such patients desire to be “full code.” The aging of the United States population, a heightened understanding of age-related vulnerabilities, and a growing focus on goal-concordant care suggest it is time to revisit this approach to decision-making regarding CPR in the perioperative setting (Anesthesiology 2021;135:781-7). Our commitment to respecting patient autonomy and patient-centered...