The following is the summary of “Prevalence, Management, and Outcomes Related to Preoperative Medical Orders for Life Sustaining Treatment (MOLST) in an Adult Surgical Population” published in the January 2023 issue of Surgery by Tanious, et al.
To analyze the relationship between the number of patients with preoperative code status talks documented and their postoperative outcomes (including mortality, readmission, and discharge disposition). A MOLST form is used to record a patient’s wishes regarding potential restrictions on treatment. Consensus on treatment is essential when operating on such individuals. Therefore preoperative discussion is necessary. Unfortunately, there needs to be more data on the frequency of these conversations and their effects after surgery. Therefore, those who underwent surgery at a tertiary care academic center in Boston, Massachusetts, over a year were included in retrospective cohort research.
The numbers show that 402 (1.8%) of the 21,787 surgical patients who met the inclusion criteria had preoperative MOLST. More than half (55.7%) of MOLST participants had limited CPR, and more than a third (214%) had limited intubation and MV. Before surgery, 169 patients with MOLST had documented discussions about code status. The median duration of stay (Q1, Q3) was 5.1 days, and 362 (or 90%) of the surgeries were elective or non-emergent (1.9, 9.9). Only around 40% of patients with preoperative MOLST were sent home, and more than a quarter (25.6%) were readmitted within 30 days.
Preoperative MOLST was associated with a higher risk of death: 9.2% (30 patients) and 14.9% (90 patients) in the 30-day and 90-day periods, respectively (60 patients). Only around half of patients undergoing surgery who receive preoperative MOLST have code status talks recorded before their procedure. Due to the high risk of postoperative mortality and the wide range of patient preferences in MOLST, it is essential to have an in-depth conversation before surgery to ensure everyone’s expectations are aligned.
