Risk Assessment in Surgical Patients: American Society of Anesthesiologist’s (ASA) Classification vs Intraoperative Therapeutic and Diagnostic Interventions (I-ITS)

Abstract

Background: In this prospective study of 859 surgical patients in a tertiary research hospital, we examined the association between ASA physical status classification and Intraoperative Therapeutic Intervention Score (I-TIS). Methodology: All patients were assigned by ASA classification before the operation and received a value of 1-4 points for I-TIS score during surgical procedures. Surgical complexity was also classified and correlation with I-TIS was examined. Results: The correlation coefficient of the ASA with I-TIS was r=0.55 (p<0.01). The correlation between the surgical complexity was r=0.66 (p<0.001). Five patients (ASA IV) with I-TIS score>25 and surgical complexity of major plus were admitted to the intensive care unit. Two of them were followed up six hours and the other three stayed more than 24 hours in the intensive care unit. Conclusions: It's concluded that I-TIS score may be validated for our surgical patients but this assessment may show variability among institutions. The ASA classification is the most valued and widely used scoring system for evaluation of perioperative risk in surgical patients. It is simple, easy and also a useful tool to assist descriptions of workload and 'anesthetic risk' for analysis and research purposes.

Risk Management of Neuroanesthesia in Traumatic Brain Injury with Multiple Facial Fractures and Subcutaneous Emphysema in terms of Ethical and Medicolegal Aspects

“…Risk management in neuroanesthesia includes preventive measures and management evaluations that have been carried out to reduce morbidity and mortality (Cabrini & Levati, 2009). The American Society of Anesthesiologists (ASA) has made a risk classification in the field of anesthesia that has been used extensively (Kumar & Kumar, 2015;Cevik & Yuce, 2018). Risk management is an effort that tends to be proactive and can also be an evaluation of previous experience to be applied in an effort to reduce or prevent similar problems in the future (Sampurna, 2004).…”

“…However, complications can occur that can not be prevented, prompt and appropriate handling of the potential risks detected is needed (Cabrini & Levati, 2009). Because of the complexity of anesthesia and surgery, risk management is very important to reduce the morbidity and mortality associated with anesthesia, although the anesthetic prosedure is not alone in determining the success of surgery because it is also influenced by the patient's health status and the complexity of the operation (Cevik & Yuce, 2018). Every medical prosedure including neuroanesthesia always contains risks so that risk management is needed (Sampurna, 2004).…”

Case Report: Case report: Administration of anticoagulant therapy after neuro-anesthesia procedure for hemorrhagic stroke patients with COVID-19 complications and its ethical and medicolegal consideration

“…36 This includes risk assessment, identification and management of patient risks, incident reporting and analysis, the ability to learn and follow up on incidents, and implement solutions to reduce and minimize risks. [36][37][38] Risk management in neuro-anesthesia includes preventive measures and management evaluations that have been carried out to reduce morbidity and mortality. 9,37 Risk management is an effort that tends to be proactive and can also be an evaluation of previous experience to be applied in an effort to reduce or prevent similar problems in the future.…”

“…9,37 Risk management is an effort that tends to be proactive and can also be an evaluation of previous experience to be applied in an effort to reduce or prevent similar problems in the future. 38 There are four risk management steps in neuro-anesthesia: (1) problem detection (2) problem assessment (3) problem resolution, and (4) verification. 37 The first step in risk management is to detect the problem, in this case, patients with hemorrhagic stroke with intracerebral bleeding have an increased risk of recurrent bleeding when given anticoagulants.…”