Abstract
The American Society of Anesthesiologists (ASA) Physical Status Classification System has been used to assess pre-anesthesia comorbid conditions for over 60 years. However, the ASA Physical Status Classification System has been criticized for its subjective nature. In this study, we aimed to assess the correlation between the ASA physical status assignment and more objective measures of overall illness.This is a single medical center, retrospective cohort study of adult patients who underwent surgery between November 2, 2017 and April 22, 2020. A multivariable ordinal logistic regression model was developed to examine the relationship between the ASA physical status and Elixhauser comorbidity groups. A secondary analysis was then conducted to evaluate the capability of the model to predict 30-day postoperative mortality.A total of 56,820 cases meeting inclusion criteria were analyzed. Twenty-seven Elixhauser comorbidities were independently associated with ASA physical status. Older patient (adjusted odds ratio, 1.39 [per 10 years of age]; 95% CI 1.37 to 1.41), male patient (adjusted odds ratio, 1.24; 95% CI 1.20 to 1.29), higher body weight (adjusted odds ratio, 1.08 [per 10 kg]; 95% CI 1.07 to 1.09), and ASA emergency status (adjusted odds ratio, 2.11; 95% CI 2.00 to 2.23) were also independently associated with higher ASA physical status assignments. Furthermore, the model derived from the primary analysis was a better predictor of 30-day mortality than the models including either single ASA physical status or comorbidity indices in isolation (p < 0.001).We found significant correlation between ASA physical status and 27 of the 31 Elixhauser comorbidities, as well other demographic characteristics. This demonstrates the reliability of ASA scoring and its potential ability to predict postoperative outcomes. Additionally, compared to ASA physical status and individual comorbidity indices, the derived model offered better predictive power in terms of short-term postoperative mortality.
Highlights
The American Society of Anesthesiologists (ASA) physical status classification system was originally designed and implemented as a tool to summarize preoperative comorbidity status [1,2,3,4], and is widely used in improving risk adjustment, determining reimbursement, and predictingThis article is part of the Topical Collection on Systems-Level Quality Improvement.perioperative risk and mortality [5,6,7], despite the explicit recommendation from the ASA House of Delegates that it not be used in isolation for risk stratification and mortality prediction [3]
In this study we aim to pragmatically model the association between ASA physical status documented in routine clinical practice and specific comorbidities included in the aforementioned comorbidity indices
In the cohort, we found that a few cardiac surgery cases for decompensated heart failure and implementation of mechanical circulatory support were assigned an ASA physical status 1 or 2
Summary
The American Society of Anesthesiologists (ASA) physical status classification system was originally designed and implemented as a tool to summarize preoperative comorbidity status [1,2,3,4], and is widely used in improving risk adjustment, determining reimbursement, and predictingThis article is part of the Topical Collection on Systems-Level Quality Improvement.perioperative risk and mortality [5,6,7], despite the explicit recommendation from the ASA House of Delegates that it not be used in isolation for risk stratification and mortality prediction [3]. The American Society of Anesthesiologists (ASA) physical status classification system was originally designed and implemented as a tool to summarize preoperative comorbidity status [1,2,3,4], and is widely used in improving risk adjustment, determining reimbursement, and predicting. Due to the classification system’s largely subjective nature, there is inconsistent assignment of ASA physical status among clinicians [8, 9]. The Charlson index was developed to predict 1-year mortality risk by assigning empirically derived scores to 19 clinically relevant comorbidities [11]. The Romano index, the most commonly used modification of Charlson index, groups the comorbidities on the basis of the International Classification of Diseases (ICD) diagnosis coding system (9th & 1 0th
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