In older adults undergoing surgery, new Do Not Resuscitate (DNR) orders often indicate significant risk factors and timing that can guide surgical decision-making.

• Only 2.3% of 47,564 cases resulted in new perioperative DNR orders.
• Key predictors of DNR orders: ASA IV/V (2.6x), disseminated cancer (3.3x), and emergent surgery (3.5x).

DNR orders typically occur early post-surgery; 32.5% were placed within 24 hours.

• Among patients who died, DNR was commonly set 5.2 days prior to death, emphasizing a need for prompt goals-of-care conversations.