Preinjury ASA score as an independent predictor of readmission after major traumatic injury

Tran, Alexandre; Mai, Trinh; El-Haddad, Julie; Lampron, Jacinthe; Yelle, Jean-Denis; Pagliarello, Giuseppe; Matar, Maher

doi:10.1136/tsaco-2017-000128

Cited by 23 publications

(22 citation statements)

References 21 publications

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“…Unlike prior studies which demonstrated higher rates of hospital readmission in trauma patients, 21 we found no association between higher ASA status and readmission among patients undergoing facial fracture repair. This study also found that ASA classification is associated with longer length of hospital stay in facial fracture repairs.…”

Section: Discussioncontrasting

confidence: 99%

“…16 ASA physical status classification has been previously used to predict increased readmission rates for orthopedic trauma and spinal fusion procedures, with the highest risk attributed to those with an ASA score of IV. 19,20 Unlike prior studies which demonstrated higher rates of hospital readmission in trauma patients, 21 we found no association between higher ASA status and readmission among patients undergoing facial fracture repair. This study also found that ASA classification is associated with longer length of hospital stay in facial fracture repairs.…”

Section: Discussioncontrasting

confidence: 96%

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ASA Physical Status Classification and Complications Following Facial Fracture Repair

Thepmankorn

Choi

Haimowitz

et al. 2021

Ann Otol Rhinol Laryngol

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Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher’s exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection ( P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications ( P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay ( P < .001) and risk of overall complications ( P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection ( P = .049), postoperative bleeding ( P = .036), and failure to wean off ventilator ( P = .027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 96%

ASA Physical Status Classification and Complications Following Facial Fracture Repair

Thepmankorn

Choi

Haimowitz

et al. 2021

Ann Otol Rhinol Laryngol

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“…The trend over time of the patients with an ASA III or ASA IV classification is just as expected based on their lower recovery possibilities because of their comorbidities. This is in line with the results of Tran et al (2017) [53] who showed that pre-injury ASA score is an independent predictor of readmission after a major injury, when assumed that this also leads to a lower health status.…”

Section: Discussionsupporting

confidence: 90%

Longitudinal analysis of health status the first year after trauma in severely injured patients

Havermans¹,

Jongh²,

Munter

et al. 2020

Scand J Trauma Resusc Emerg Med

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Purpose: While survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma. Methods: A multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed. Results: In total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition. Conclusions: Lower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.

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“…There are several possible explanations on these findings such as the 3 rd quintile had the highest percentage of patients with ASA classification ≥ 3. High ASA classification has been shown to be an independent predictor of readmission after major traumatic injury and general surgery[18,19].…”

Section: Discussionmentioning

confidence: 99%

Learning curve of enhanced recovery after surgery program in open colorectal surgery

Lohsiriwat

2019

WJGS

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BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery. METHODS This was a review of prospectively collected database of 380 “unselected” patients undergoing elective “open” colectomy and/or proctectomy under ERAS protocol from 2011 (commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups (76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery: defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission. RESULTS Hospitalization more than 5 d occurred in 22.6% ( n = 86), major complication was present in 2.9% ( n = 11) and 30-d readmission rate was 2.4% ( n = 9) accounting for unsuccessful recovery of 25% ( n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles ( P < 0.001). Average compliance with ERAS protocol gradually increased over the time - from 68.6% in 1 st quintile to 75.5% in 5 th quintile ( P < 0.001). The application of preoperative counseling, nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period. CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.

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Preinjury ASA score as an independent predictor of readmission after major traumatic injury

Cited by 23 publications

References 21 publications

ASA Physical Status Classification and Complications Following Facial Fracture Repair

ASA Physical Status Classification and Complications Following Facial Fracture Repair

Longitudinal analysis of health status the first year after trauma in severely injured patients

Learning curve of enhanced recovery after surgery program in open colorectal surgery

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