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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Clinical course after end of life decisions on a neurosurgical ward – much to learn and improve

Der klinische Verlauf nach „end of life“ Entscheidung auf einer neurochirurgischen Normalstation – was wir lernen und verbessern können

Meeting Abstract

  • presenting/speaker Xenia Hautmann - Georg-August-Universität Göttingen, Göttingen, Deutschland
  • Veit Rohde - Georg-August-Universität Göttingen, Göttingen, Deutschland
  • Christian von der Brelie - Georg-August-Universität Göttingen, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP079

doi: 10.3205/20dgnc366, urn:nbn:de:0183-20dgnc3660

Published: June 26, 2020

© 2020 Hautmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: End-of-life (EoL) decisions are, unfortunately, a routine part in neurosurgical care due to frequent devastating diagnoses resulting in a severely impaired prognosis. Patients’ provision, discussions with patients´ representatives and evaluation of the alleged will play an increasing role in decision making. Institutional standards, ethics climate, different ethnical backgrounds and individual physicians’ values, experiences and emotions might impact judgements and decisions, thus the clinical course after EoL decisions is challenging. The aim of this study is to characterize the clinical course of moribund patients on a neurosurgical general ward with special emphasis on sufficiency of palliation care.

Methods: This is a retrospective observational analysis. All patients who died between 2014 and 2019 on a neurosurgical general ward were included. Baseline parameters were analyzed. It was checked if an active EoL decision was made and if it was in-line with either a patient´s provision or the alleged patient´s will. The clinical course was further analyzed with regard to palliation therapy and support. Analyzing documentations it was categorized if a palliation therapy was carried out sufficiently. Consequential palliation was categorized if care contained withdrawal of medication, food and a restrictive thirst-oriented fluid management.

Results: 168 patients were included. Given a mean annual caseload of 3000/year this accounts for 0.1%. 79.9% had a cranial diagnosis (20.1% spinal). Only 22.6% of all patients suffered from oncological diagnoses. 62.6 % of all patients died because of intracranial diagnoses (22% due to systemic sepsis, 15.4% due to cardiocirculatory deficiency).

EoL decisions were made in 84.1%. Of those patients, only 33.6% had a patient´s provision. EoL was consented with the patients´ relatives in 87.4%. Medication withdrawal (WD) was performed in 82.1% (food WD in 86.8%, permanent fluid WD in only 39.1%). Sufficient control for dyspnea was achieved in 51.4%, pain control in 90.9% and agitation control in 66.7%. It took a mean duration of 2.1 days (range 0 – 20 days) from the EoL until the patient died. Consequential palliation lead to a shorter duration until death (2.4 ±2.3 vs. 1.2± 0.9 days, p = 0.001).

Conclusion: Even though symptoms are carefully watched for sake of palliation, dyspnea and agitation are difficult to control. If an EoL decision is reached, consequential palliation should be carried out in order to limit suffering of moribund patients.