4464 Can the asa grade predict the risk of endoscopic complications?

Abstract

Background:The American Society of Anesthesiologists (ASA) grade has been used for over 50 years as a predictor of risk for perioperative morbidity and mortality. This measure has been incorporated into the CORI endoscopic database as a potential stratification tool for adverse outcomes related to endoscopy. There are 5 designated levels, ranging from Class Ihealthy patient without comorbidities, to Class V-moribund paient with little chance of survival. Purpose: To utilize a national endoscopic database (CORI) to asses the predicitve ability of the ASA grade for endoscopic complications. Methods:A physician network of 116 endoscopists at 32 sites entered data from 6/30/97-9/30/99. 141,572 endoscopic exams were performed on 104,311 unique patients. EGD, colonoscopy, ERCP and FS exams were used for this study. The ASA grade was entered in 81% of cases. Multivariate analysis, controlling for age and gender was performed to assess the association of ASA grade and risk for complications. This analysis was performed separately for total complications and bleeding and/or perforation. ASA grade V was not analyzed due to the low number of cases (50). Conclusions: The ASA grade strongly predicts the risk of overall complications and the subset with bleeding and/or perforation secondary to endoscopy. The risk of complications for grade IV patients appears 4-8X greater than grade I patients. The ASA grade may be used to stratify the risk of endoscopic complications and as an adjustment tool for patient case-mix.