Challenges in perioperative code status management: a national survey among Swiss anaesthetists

To evaluate current practices and beliefs among anaesthetists regarding perioperative code status discussions and management in surgical patients. A nationwide web-based survey was conducted in Switzerland among anaesthesia providers. Primary endpoint: proportion of participants routinely discussing code status with medium-risk patients based on the American Society of Anesthesiologists (ASA) physical status classification system (ASA 3-4). Secondary endpoints: proportion of code status discussions in low-risk (ASA 1-2) and high-risk (ASA 5) patients; perioperative intensive care unit (ICU) admissions, severe complications, therapy limitations and management of patients with Do Not Resuscitate (DNR) orders. Of 496 respondents, 474 were included. 56.8% (n=269) of anaesthetists reported routinely discussing code status with medium-risk patients (ASA 3-4). Factors associated with routine code status discussion included greater experience (mean [± SD] 20.7 [± 10.6] vs. 17.4 [10.8] years, adjusted OR 1.03 [95% CI 1.02 to 1.05], p<0.001), more exposure to cardiopulmonary resuscitation (CPR) (≥50 CPRs: 69/269 [62.8%] vs. 93/205 [45.4%]; adjusted OR 2.99 [95% CI 1.39 to 6.42], p=0.005), and awareness of institutional teaching (48/243 [19.8%] vs. 13/180 [7.2%], adjusted OR 2.93 [95% CI 1.51 to 5.68], p=0.001), though only 14.4% reported such training. 76.3% (n=318) of anaesthetists reported discussing code status preoperatively with patients who have DNR orders. While 70.4% (n= 285) supported respecting DNR orders perioperatively, 21.3% (n=86) felt they should not apply. Code status discussions are commonly reported for medium-risk patients, but formal education is limited. Experience and clinical exposure increase the likelihood of such discussions. Enhanced training and clearer guidelines are needed to support consistent ethical management of code status in the perioperative setting.