Do Not Resuscitate Orders and Outcomes for Patients with Pancreatic Cancer

Background: The impact of do-not-resuscitate (DNR) order on patients with pancreatic cancer remains uncertain. In this study, we evaluated whether DNR status was associated with in-hospital mortality and costs for the inpatient stay among patients hospitalized with pancreatic cancer. Methods: : Data were from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and included 40,246 pancreatic cancer admissions between 2011 and 2016. Mortality was modeled using a logistic regression model; costs for the inpatient stay were modeled using a multivariable generalized linear regression model. Results: : The sample included 6,041 (15%) patients with a documented DNR. After controlling for covariates, patients with a DNR order had approximately 6 times greater odds of mortality compared to patients without a DNR order (OR 5.90, p<0.0001). Compared to patients without a DNR order who survived during the hospital stay, patients with a DNR order who died during the hospital stay had significantly lower costs (-US$983; p=0.0270), and patients without a DNR order who died during the hospital stay had significantly higher costs (US$5,638; p<0.0001). Patients with a DNR order who survived had costs that were not significantly different from patients without a DNR order who survived. Conclusions: : The presence of a DNR order among patients with pancreatic cancer was significantly associated with higher mortality risk, as well as lower costs for the patients who died during the hospital stay. However, DNR status was not significantly associated with costs for patients with pancreatic cancer who were discharged alive.