HACCP-METHOD PRE-PROCEDURAL CLEARANCE: IS ASA-PS THE FIRST CRITICAL CONTROL POINT?

Abstract

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Hazard Analysis, Critical Control Point (HACCP) method is a pre-emptive safety strategy whereby critical control points (CCP) are idenitified and risk mitigation strategies are employed to eliminate or reduce that risk. Mortality risk is the most critical immediate complication for initial identification in pre-procedural clearance for planned procedures. The American Society of Anesthesiologists’ Physical Status (ASA-PS) classification system has historically been used as a grading tool for preoperative health of surgical patients to identify postoperative complication risk. Our objective was to perform a systematic review of current studies for the purpose of defining the accuracy and predictive value of ASA-PS scoring with regard to adult patients undergoing scheduled procedures to determine if the ASA-PS score could be used as a first CCP (risk of mortality) in order to apply risk mitigation pre-emptively. METHODS: Three databases were searched (PubMed, Ovid Medline, and CINAHL) between 2009 and 2019 by the research team. We included published English language, randomized control trials, systematic reviews, meta-analysis, and cohort studies that considered the ASA-PS classification for patients undergoing scheduled surgeries and their postoperative mortality.The Joanna Briggs Institute Clinical Appraisal tools were used by student and faculty researchers to rate study quality after inclusion and exclusion criteria were applied. RESULTS: 11 studies met the inclusion criteria; they provided a total of 3,092,064 patients undergoing scheduled elective surgery. American Society of Anesthesiologist (ASA) physical status score had a stepwise increase in risk of mortality with concurrent increases in ASA-PS. Of the 11 studies included for final analysis, 6 studies assessed mortality rates by ASA class, ranging from 0%-0.02% for ASA 1, 0.14%-0.02% for ASA 2, 1.41%-4.41% for ASA 3, 9.8%-16.67% for ASA 4, and 13%-50.87% for ASA 5. CONCLUSIONS: A literature review using data from the past 10 years, re-affirmed the relationship between ASA-PS score and perioperative mortality. As the initial critical control point in a HACCP patient safety model for pre-procedural clearance, identification of an ASA-3 score defined a cut-off that should trigger risk mitigation measures. Specific evidence-based and professional society consensus recommendations are available for patients defined as ASA-3 or above and should be implemented as part of an optimal pre-procedural clearance and risk mitigation strategy. CLINICAL IMPLICATIONS: In a HACCP model, patient ASA-PS score is an excellent initial CCP, showing a significant increase in mortality at > or = 3 in patients who are undergoing procedures requiring moderate-to-deep anesthesia. Evidence-based risk mitigation strategies are available and include pre-op evaluation by anesthesia practice prior to admission for the procedure and additional CCP screenings. DISCLOSURES: No relevant relationships by Peter Kallio, source=Web Response No relevant relationships by Michael Koscielniak, source=Web Response No relevant relationships by Karen O Mara, source=Web Response No relevant relationships by Robin Tsai, source=Web Response