Intraoperative code status: Moving from misinformation to respect for patient autonomy.

Document Type

Article

Publication Date

1-2026

Publication Title

Surgery

Abstract

BACKGROUND: Intraoperative code status remains a complicated topic for patients and providers. Previous studies have demonstrated a lack of understanding of intraoperative do not resuscitate status. Few studies have used simulation-based education for surgical residents to navigate conversations with patients who request intraoperative do not resuscitate status. This project aims to implement a simulation-based curriculum for residents to navigate intraoperative do not resuscitate status while maintaining and fostering respect for patient autonomy.

METHODS: Anesthesiology and surgery residents were surveyed regarding clinical practice and policy surrounding intraoperative code status, which demonstrated a knowledge gap. To address this, a simulation-based curriculum was developed wherein surgery residents encounter a standardized patient who requests intraoperative do not resuscitate status. A posttraining survey assessed the effectiveness of this simulation.

RESULTS: Targeted needs assessment demonstrated 56.5% of surgery residents incorrectly believed do not resuscitate status must be rescinded for an elective operation and 52.1% believed this for an emergent operation. Results from posttraining survey responses demonstrated a statistically significant (P < .001, Figure 1) change in confidence discussing intraoperative do not resuscitate status and a statistically significant reduction in the misconception that a do not resuscitate order must be rescinded before surgery (P < .01, Figure 2).

CONCLUSION: A simulation-based curriculum was created to meet the need for clear discussion of intraoperative do not resuscitate policy while emphasizing respect for patient autonomy. Posttraining survey demonstrated a significant increase in confidence and understanding when discussing intraoperative do not resuscitate status and ethics policy. Our future aims will assess curriculum impact on practice patterns and hospital outcomes via a 6-month follow-up survey.

Volume

189

First Page

109822

DOI

10.1016/j.surg.2025.109822

ISSN

1532-7361

PubMed ID

41107130

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