New DNR orders in older adults often occur shortly after surgery, revealing a need for improved palliative care discussions in high-risk cases.

• Among 47,564 older surgical patients, 2.3% had a new DNR order within 30 days post-surgery.
• Predictors for new DNR orders include ASA class IV/V (OR 2.6), disseminated cancer (OR 3.3), emergent surgery (OR 3.5), malnutrition (OR 2.3), and postoperative delirium (OR 2.3).
• Notably, nearly one-third of DNR orders were placed within 24 hours post-surgery, emphasizing the urgency for proactive goals-of-care discussions.

This study suggests that earlier, structured discussions about care expectations could be beneficial in managing high-risk surgical patients.