Objective: To investigate Do-not-resuscitate (DNR) order utilization in Parkinson’s disease (PD) hospitalizations patients in the United States.

Background: DNR order utilization in PD has been recognized to be as much an emphasis on quality of life, as it is on perception of imminent end of life. While DNR utilization is a complex phenomenon due to the subjectivity and individuality associated with the decision, the effect of such a decision can collectively influence attitudes of care and have a ripple effect beyond the individual patient level.

Methods: We reviewed the Healthcare Cost and Utilization Project’s National Inpatient Sample (NIS) database from 2012 for all hospitalizations >=65 years. We identified PD by using ICD-9-CM code 332.0 and DNR status with ICD code – V49.86 entered during the same admission as a secondary diagnosis. We estimated risk of mortality by the 3M™ All Patient Refined DRG (APR DRG) classification System and generated multivariate regression models to assess associations between DNR and PD after adjusting for confounders. Finally, we tested for interaction by risk of mortality.

Results: We analyzed 12,700,000 hospitalizations with age>=65 years in 2012, of which 246625 (1.94%) pts had PD. Overall, DNR utilization was seen in 743985 (5.9%) patients. Proportion of DNR utilization was higher among PD patients vs. those without, 20895 (8.47%) vs. 723090 (5.8%) (P: < 0.01). In multivariable regression analysis, PD patients were associated with higher odds of DNR utilization [Adjusted Odds ratio (aOR): 1.26, 95% CI: 1.21, 1.30, P < 0.001] after adjusting for patient level, hospital level characteristics and risk of mortality. Finally, the odds of DNR utilization increased significantly with APR-DRG stage [aOR: 1 vs 1.61(Stage 2) vs 2.46 (Stage 3) vs 3.61 S(Stage 4); p<0.0001].

Conclusions: PD patients have higher odds of DNR utilization than the general population, which worsens with increasing objective risk of mortality. This is likely correlated with perception of end of life and importance of QOL with increasing severity of overall illness. Further objective exploration of the factors leading to this decision can help us provide better care. *Abhimanyu and Achint have contributed equally. Christos and Girish have contributed equally.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/do-not-resuscitate-utilization-in-inpatient-parkinsons-disease-in-the-united-states/