Predictors of change in code status from time of admission to death in critically ill surgical patients

Laura N. Purcell, Christopher J. Tignanelli, Rebecca Maine, Anthony Charles

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Racial and gender disparities in end-of-life decision-making practices have not been well described in surgical patients. We performed an eight-year retrospective analysis of surgical patients within the Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. ICU patients with documented admission code status, and death or ICU discharge code status, respectively, were included. Logistic regression analysis was performed to assess change in code status. Of 468,000 ICU patients, 97,968 (20.9%) were surgical, 63,567 (95%) survived, and 3,343 (5%) died during their hospitalization. Of those, 50,915 (80.1%) and 2,625 (78.5%) had complete code status data on admission and discharge or death, respectively. Women were less likely than men to remain full code at ICU discharge and death (n 5 20,940, 95.6% and n 5 141, 11.9% vs n 5 29,320, 97.4% and n 5 233, 16.3%, P < 0.001). Compared with whites, blacks and other minorities had a 0.46 odds (95% confidence interval [CI]: 0.33–0.64, P < 0.001) and 0.54 odds (95% CI: 0.34–0.85, P 5 0.01) of changing from full code status before death, respectively. Before ICU discharge, blacks and other minorities had a 0.56 odds of changing from full code status when compared with whites (95% CI: 0.40–0.79, P < 0.001 vs 95% CI: 0.36–0.87, P 5 0.01, respectively). Women were more likely to be discharged or die after a change in code status from full code (odds ratio 1.27, 95% CI: 1.06–1.07, P < 0.001; odds ratio 1.39, 95% CI: 1.09–1.79, P 5 0.009). Men and minorities are more likely to be discharged from the ICU or die with a full code status designation.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalAmerican Surgeon
Issue number3
StatePublished - 2020

Bibliographical note

Publisher Copyright:
© 2020 Southeastern Surgical Congress. All rights reserved.


  • Adult
  • African Americans/statistics & numerical data
  • Aged
  • Cardiopulmonary Resuscitation/mortality
  • Cause of Death
  • Clinical Decision-Making
  • Confidence Intervals
  • Critical Illness/mortality
  • Databases, Factual
  • Female
  • Health Care Surveys
  • Hospital Mortality/trends
  • Humans
  • Intensive Care Units/statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Minority Groups
  • Outcome Assessment, Health Care
  • Patient Admission
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Surgical Procedures, Operative

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study


Dive into the research topics of 'Predictors of change in code status from time of admission to death in critically ill surgical patients'. Together they form a unique fingerprint.

Cite this