SP2.4 The impact of preoperative American Society of Anesthesiologists grade on major pancreatoduodenectomy outcomes

Abstract

Abstract American Society of Anesthesiologists (ASA) grade is often used as a crude assessment for grading patients prior to major surgery, such as pancreaticoduodenectomy (PD). Patients deemed to have a high ASA grade may not be offered resection. Increasing ASA grade is known to correlate with increasing morbidity and mortality rates. Prior authors have argued that caution should be used when offering PD to ASA grade >II patients. This study aimed to compare the outcomes of PD patients with a low ASA grade (I-II) with high ASA grade (>II). Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Patients were grouped by their ASA grade. The outcomes of interest were median length of stay (LoS), 30-day readmission, 90-day mortality and five-year survival. Comparisons were made using the Mann-Whitney U test and the Fisher exact test. Out of 1484 cases, 1365 (92.0%) had information regarding their ASA grade available. Of these, 973 (71.3%) were ASA grade I-II and 392 (28.7%) were ASA grade >II. Whilst those with a high ASA grade had significantly longer LoS (14 vs 13 days, p<0.0001), 30-day readmission (8.5% vs 11.7% p=0.1), 90-day mortality (3.1% vs 4.6%, p=0.2) and five-year survival (32.5% vs 28.8%) rates were similar. In our multicentre study of PD patients, high ASA grade correlated with increased LoS. However, a high ASA grade did not affect the other studied outcomes. Therefore, higher ASA grade alone should not be an absolute contraindication to PD.