ASA classification and in-hospital deaths in surgery

Abstract

Background: ASA (American Society of Anesthesiologists’) classification appears to have a direct relationship to in-hospital mortality in surgery,provided other factors that can equally affect mortality are favorable.Aims and objectives: To study the relationship between ASA classification and in-hospital mortality within the surgical service in our center.Design: Retrospective study.Setting: Nnamdi Azikiwe University Teaching Hospital, a tertiary institution serving rural, semi-urban and urban communities.Patients and methods: Searching through the records, all the in-hospital deaths that occurred in our center between 1st August 1999 and 31st July2006, a 7-year period, were studied with a view to seeing what the ASA classification of the patients were at the time they were admitted, nature ofsurgical intervention, type of anesthesia, time of death after admission/surgery, and cause of death.Results: A total of 251 in-hospital deaths occurred in the surgical service during the period under review. However, only 106 of the patients(42.2%) had records of ASA classification before death. These were recruited into this study. Ten of the patients (9.4%) were in ASA classification V; 57 (53.8%) were in ASA IV; 32 (30.2%) in ASA III and only seven (6.6%) were in ASA II. None of the patients was in ASA I or ASA VI.Seventy-six patients (71.7%) presented as emergencies.Conclusion: There appears to be a direct relationship between ASA classification and the rate of in-hospital mortality within the surgical service:higher ASA classification being associated with higher in-hospital deaths.