Comparative evaluation of ASA classification and ACE-27 index as morbidity scoring systems in oncosurgeries

Abstract

The primary intention of the study was to find out whether Adult Comorbidity Evaluation Index (ACE-27) was better than the American Society of Anaesthesiologists’ (ASA) risk classification system in predicting postoperative morbidity in head and neck oncosurgery. Another goal was to identify other risk factors for complications which are not included in these indexes. Univariate and multivariate analyses were performed on 250 patients to determine the impact of seven variables on morbidity-ACE-27 grade, ASA class, age, sex, duration of anaesthesia, chemotherapy and radiotherapy. In univariate analysis ACE-27 index, ASA score, duration of anaesthesia, radiotherapy and chemotherapy were significant. As both comorbidity scales were significant in univariate analysis they were analyzed together and separately in multivariate analysis to illustrate their individual strength. In the first multivariate analysis (excluding ACE-27 grade) ASA class, duration of anaesthesia, radiotherapy and chemotherapy were significant. The positive predictive value (PPV) of this model to predict morbidity was 60.86% and negative predictive value (NPV) was 77.9%. The sensitivity was 75% and specificity 62.2%. In the second multivariate analysis (excluding ASA class) ACE-27 grade, duration of anaesthesia and radiotherapy were significant. The PPV of this model to predict morbidity was 62.1% and NPV was 76.5%. The sensitivity was 61.6% and specificity 70.9%. In the third multivariate analysis which included both ACE-27 grade and ASA class only ASA class, duration of anaesthesia, radiotherapy and chemotherapy remained significant. In conclusion, ACE-27 grade and ASA class were reliable predictors of major complications but ASA class had more impact on complications than ACE-27 grade.

T3‐T4 laryngeal cancer in The Netherlands Cancer Institute; 10‐year results of the consistent application of an organ‐preserving/‐sacrificing protocol

“…Various studies reported that patients with positive neck nodes have worse prognosis . Also, ASA scores have been reported to be predictive for morbidity and mortality as well as chance for successful organ preservation …”

“…18,24 Also, ASA scores have been reported to be predictive for morbidity and mortality as well as chance for successful organ preservation. [25][26][27] Next to survival, quality of life, toxicity, and larynx preservation are important parameters in the decisionmaking process. Both organ sacrificing and preserving treatments for advanced laryngeal cancer significantly affect quality of life.…”

Hospital stay following complex major head and neck resection: what factors play a role?

“…Stress of surgery and anaesthesia can induce various metabolic and endocrine changes, such as hypothermia, hypovolaemia, tissue hypoperfusion, leading to greater postoperative morbidity, including wound infection and delayed healing . Duration of general anaesthesia has been confirmed to be a significant factor in increasing complications, with anaesthesia time greater than 8 h found to be an independent predictor of postoperative morbidity …”

“…8,9 Duration of general anaesthesia has been confirmed to be a significant factor in increasing complications, with anaesthesia time greater than 8 h found to be an independent predictor of postoperative morbidity. 7,10 Co-morbidity has been found to have a significant impact on treatment selection, LOS, postoperative complications and survival in several types of malignancies, including head and neck cancer. 11 Interestingly, our study showed no significant correlation between ACE-27 index grades 2 and 3 and LOS.…”

Is benchmarking possible in audit of early outcomes after operations for head and neck cancer?

“…On univariate analysis, comorbidity indicies, namely the Adult Comorbidity Evaluation (ACE-27) and the American Society of Anesthesiologists' (ASA) scores, are associated with perioperative risk and this has been corroborated by other recent publications. 22,23 Further investigation of data is likely to result in one or more of these scores being included in an updated risk adjustment model for head and neck surgery. Laryngeal operations, when singled out as an anatomical site, added significantly to risk.…”