"Do not resuscitate" (DNR) orders in the perioperative period--a comparison of the perspectives of anesthesiologists, internists, and surgeons.

The purpose of this descriptive study is to compare and contrast the experience, perceptions, and opinions of practicing anesthesiologists, internists, and surgeons regarding "do not resuscitate" (DNR) orders in the perioperative period. A questionnaire was mailed to 600 internists and 600 surgeons. Responses from these two groups were analyzed and compared with the results of a previously reported survey of 420 anesthesiologists. One hundred ninety-two of 570 (34%) and 199/584 (34%) acknowledged responses were received from internists and surgeons, respectively. Anesthesiologists (114/190; 60%) were more likely than internists (61/182; 34%) or surgeons (71/194; 37%) to assume DNR suspension in the perioperative period and were less likely than their colleagues to discuss with the patient the implications of their DNR order during anesthesia and surgery. This assumption of DNR suspension by anesthesiologists was underestimated by both surgeons and internists. Anesthesiologists and surgeons were more similar than internists in their manner of utilization of resuscitative measures in the setting of a cardiopulmonary arrest. All groups were more likely to require DNR suspension for elective than for palliative cases. The majority of all groups concurred that physician responsibility for defining DNR status in the perioperative period should be shared by the anesthesiologist, surgeon, and primary care physician and not prescribed by hospital policy. The manner in which a DNR order is perceived in the perioperative period varies considerably among specialties and warrants further discussion among these groups.