The Assignment of American Society of Anesthesiologists Physical Status Classification for Adult Polytrauma Patients: Results From a Survey and Future Considerations

Kuza, Catherine M.; Hatzakis, George; Nahmias, Jeffry

doi:10.1213/ane.0000000000002450

Cited by 32 publications

(25 citation statements)

References 38 publications

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“…Not only is accuracy of the ASA-PS class necessary to ensure the appropriate preoperative workup, but consistent ASA-PS classification also ensures accuracy of survival prediction models as well as quality comparisons among institutions (Skaga et al 2007 ; Kuza et al 2017 ). The ASA-PS class is also used by NSQIP to compare quality of care among hospitals.…”

Section: Discussionmentioning

confidence: 99%

Clinical agreement in the American Society of Anesthesiologists physical status classification

2018

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BackgroundThe American Society of Anesthesiologists physical status (ASA-PS) classification is not intended to predict risk, but increasing ASA-PS class has been associated with increased perioperative mortality. The ASA-PS class is being used by many institutions to identify patients that may require further workup or exams preoperatively. Studies regarding the ASA-PS classification system show significant variability in class assignment by anesthesiologists as well as providers of different specialties when provided with short clinical scenarios. Discrepancies in the ASA-PS accuracy have the potential to lead to unnecessary testing and cancelation of surgical procedures. Our study aimed to determine whether these differences in ASA-PS classification were present when actual patients were evaluated rather than previously published scenario-based studies.MethodsA retrospective chart review was completed for patients >/= 65 years of age undergoing elective total hip or total knee replacements. One hundred seventy-seven records were reviewed of which 101 records had the necessary data. The outcome measures noted were the ASA-PS classification assigned by the internal medicine clinic provider, the ASA-PS classification assigned by the Pre-Anesthesia Unit (PAU) clinic provider, and the ASA-PS classification assigned on the day of surgery (DOS) by the anesthesia provider conducting the anesthetic care.ResultsA statistically significant difference was shown between the internal medicine and the PAU preoperative ASA-PS designation as well as between the internal medicine and DOS designation (McNemar p = 0.034 and p = 0.025). Low kappa values were obtained confirming the inter-observer variation in the application of the ASA-PS classification of patients by providers of different specialties [Kappa of 0.170 (− 0.001, 0.340) and 0.156 (− 0.015, 0.327)].ConclusionsThere was disagreement in the ASA-PS class designation between two providers of different specialties when evaluating the same patients with access to full medical records. When the anesthesia-run PAU and the anesthesia assigned DOS ASA-PS class designations were evaluated, there was agreement. This agreement was seen between anesthesia providers regardless of education or training level. The difference in the application of the ASA-PS classification in our study appeared to be reflective of department membership and not reflective of the individual provider’s level of training.

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Section: Discussionmentioning

confidence: 99%

Clinical agreement in the American Society of Anesthesiologists physical status classification

2018

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“…Perioperative variables were collected from the hospital's electronic records system; baseline characteristics included age, sex, body mass index (BMI, kg/m 2 ), albumin (ALB) level, previous abdominal surgery history, carbohydrate antigen 19-9 (CA 19-9) level, and American Society of Anesthesiologists Physical Status Classification (ASA score) [20]. We defined portal vein (PV)/superior mesenteric vein (SMV) abutment as PV/SMV compression or lumen narrowing.…”

Section: Definitionsmentioning

confidence: 99%

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

et al. 2020

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Background This study aimed to compare the short-term outcomes of open and robotic-assisted distal pancreatectomy (ODP and RDP) for benign and low-grade malignant tumors. Methods The patients who underwent RDP and ODP for benign or low-grade malignant pancreatic tumors at our center were included. After PSM at a 1:1 ratio, the perioperative variations in the two cohorts were compared. Results After 1:1 PSM, 219 cases of RDP and ODP were recorded. The RDP cohort showed advantages in the operative duration [120 (90-150) min vs 175 (130-210) min, P < 0.001], estimated blood loss [50 (30-175) ml vs 200 (100-300) ml, P < 0.001], spleen preservation rate (63.5% vs 26.5%, P < 0.001), infection rate (4.6% vs 12.3%, P = 0.006), and gastrointestinal function recovery [3 (2-4) vs. 3 (3-5), P = 0.019]. There were no significant differences in postoperative pancreatic fistula, postoperative hemorrhage, and delayed gastric emptying. Multivariate analysis showed that RDP (HR 0.24; 95% CI 0.16-0.36,

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“…Our results provide real-world evidence of differences in ASA scoring between surgeons and anesthesiologists after the 2014 ASA score modi cation, which have previously been studied only in hypothetical scenarios [18,24] or between anesthesiologists and Internal Medicine providers. [25] Furthermore, we found that discordant ASA scores are associated with adverse outcomes, particularly when the surgeonassigned ASA score is lower.…”

Section: Discussionmentioning

confidence: 71%

Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

Kwa

Cui

Lim

et al. 2021

Preprint

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BackgroundThe American Society of Anesthesiologists Physical Status Classification (ASA) score is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA scoring among healthcare providers. However, there is a paucity of concordance studies using real-world data, as well as studies of clinical factors or patient outcomes associated with discordant scoring. The study aims to assess real-world ASA score concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. MethodsThis retrospective cohort study was conducted in a tertiary academic medical center on 46284 consecutive patients undergoing elective surgery between January 2017 and December 2019. ASA scores entered by surgeons and anesthesiologists, patient demographics, and post-operative outcomes were collected. We assessed the concordance of preoperative ASA scoring between surgeons and anesthesiologists, clinical factors associated with score discordance, the impact of score discordance on clinically important outcomes, and the discriminative ability of the two scores for 30-day mortality, 1-year mortality, and intensive care unit (ICU) admission. Statistical tests used included Cohen’s weighted 𝜅 score, chi-square test, t-test, unadjusted odds ratios and logistic regression models. ResultsThe ASA score showed moderate concordance (weighted Cohen’s 𝜅 0.53) between surgeons and anesthesiologists. 15098 patients (32.6%) had discordant scores, of which 11985 (79.4%) were scored lower by surgeons. We found significant associations between discordant scores and anesthesiologist-assessed comorbidities, patient age and race. Patients with discordant scores had a higher risk of 30-day mortality (odds ratio 2.00, 95% confidence interval [CI] = 1.52-2.62, p<0.0001), 1-year mortality (odds ratio 1.53, 95% CI = 1.38-1.69, p < 0.0001), and ICU admission >24 hours (odds ratio 1.69, 95% CI = 1.47-1.94, p< 0.0001), and stratified analyses showed a trend towards higher risk when the surgeons’ ASA score was lower. ConclusionsThere is moderate concordance between surgeons and anesthesiologists in assigning the ASA classification. Discordant ASA scores are associated with adverse patient outcomes. Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.

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The Assignment of American Society of Anesthesiologists Physical Status Classification for Adult Polytrauma Patients: Results From a Survey and Future Considerations

Cited by 32 publications

References 38 publications

Clinical agreement in the American Society of Anesthesiologists physical status classification

Clinical agreement in the American Society of Anesthesiologists physical status classification

Robotic-assisted versus open distal pancreatectomy for benign and low-grade malignant pancreatic tumors: a propensity score-matched study

Discordant American Society of Anesthesiologists Physical Status Scoring between Anesthesiologists and Surgeons Is Correlated With Adverse Patient Outcomes: A Retrospective Cohort Study of 46284 Elective Surgical Patients

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