Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures

Schüpper, Alexander J.; Shuman, William H; Baron, Rebecca B; Neifert, Sean N; Chapman, Emily; Gilligan, Jeffrey; Gal, Jonathan S.; Caridi, John M.

doi:10.1007/s43390-020-00176-4

Cited by 16 publications

(10 citation statements)

References 38 publications

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“…ASA physical status classification has been suggested as a tool for preoperative risk stratification in spine surgery by a number of previous studies [ 4 , 5 , 17 - 19 ], although it should be noted that this was not the measure’s originally intended purpose. Rather, the ASA classification was designed to be used as a concise way of conveying a patient’s health status, primarily for statistical analysis and interprovider communication.…”

Section: Discussionmentioning

confidence: 99%

“…Rather, the ASA classification was designed to be used as a concise way of conveying a patient’s health status, primarily for statistical analysis and interprovider communication. Nonetheless, a host of researchers have reported greater rates of complications, extended postoperative stay, and readmissions among spine patients with an ASA classification > II [ 5 , 17 – 19 ]. Specific to the posterior approach, prior studies looking at 30-day readmissions and complication rates noted that patients with an ASA > III who underwent either a posterior lumbar interbody fusion or TLIF were at increased risk (odds ratio, 1.411; p<0.001; 95% confidence interval, 1.177–1.692) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2022

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Objective: The American Society of Anesthesiologists (ASA) physical classification has been used to risk stratify surgical candidates. Our study compares outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures based on preoperative ASA classification.Methods: A surgical registry was reviewed for primary, single-level MIS TLIF patients. Patients were categorized by preoperative ASA score: ASA 1, ASA 2, ASA 3+. Perioperative complications were compared among groups. PROMs for back pain, leg pain, physical function, and disability were recorded preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. PROM improvement from baseline (ΔPROM) and minimum clinically important difference (MCID) achievement was calculated for each timepoint and compared among groups. MCID achievement was determined as Δ PROMs that surpassed previously established MCID values.Results: Of the 487 patients, 64 had an ASA classification of 1, whereas 336 had an ASA of 2, and 87 had an ASA of 3 or greater. Rates of complications were not associated with ASA classification (all p>0.050).Neither mean PROM scores nor ΔPROM scores were significantly associated with ASA classification at any timepoint (all p>0.050). MCID achievement was significantly associated with ASA classification for back pain at 1-year only (p=0.041). Overall MCID achievement was not significantly associated with ASA classification for any PROM (p>0.050). Conclusion:While ASA classification has been commonly used to risk stratify surgical candidates for spinal procedures, patients with an ASA of 3 or greater may be able to achieve similar long-term outcomes following MIS TLIF given proper selection criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2022

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“…31 Another factor that influenced readmissions was the classification of the patient with an ASA score greater than III. According to Schupper et al, 32 this ASA classification is directly correlated with a more complicated postoperative hospital protocol, including a longer hospital stay and, consequently, an increase in treatment--related costs. Moreover, patients in ASA classes III and IV usually require more Intensive Care Unit admissions compared to patients without systemic disease.…”

Section: Discussionmentioning

confidence: 99%

Identification of Risk Factors Associated With 30-Day Readmission of Patients Submitted to Anterior or Posterior Access Cervical Spine Surgery

et al. 2022

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Aim: To conduct a systematic review of the literature to identify risk factors associated with 30-day readmission of patients submitted to anterior or posterior access cervical spine surgery. Methods: The databases used to select the papers were PubMed, Web of Science, and Cochrane, using the following search strategy: patient AND readmission AND (30 day OR “thirty day” OR 30-day OR thirty-day) AND (spine AND cervical). Results: Initially, 179 papers that satisfied the established search stringwere selected. After reading the titles and abstracts, 46 were excluded from the sample for not effectively discussing the theme proposed for this review. Of the 133 remaining papers, 109 were also excluded after a detailed reading of their content, leaving 24 that were included in the sample for the meta-analysis. Conclusions: The average readmission rate in the studies evaluated was 4.85%. Only the occurrence of infections, as well as the presence of patients classified by the American Society of Anesthesiology (ASA) assessment system with scores greater than III, were causal factors that influenced the readmission of patients. No significant differences were noted when comparing the anterior and posterior surgical access routes. Level of evidence II; Systematic Review of Level II or Level I Studies with discrepant results.

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“…Spine Surgery costs up to 200,000 Euros. (Schupper.J.A, Shuman.H.W, Baron.B.R et al, 2021) Another example is the increased body weight in children, due to inactivity and unhealthy diet. In the diet and weight reduction program, relevant experts in the field of nutrition are involved.…”

Section: Primary Preventionmentioning

confidence: 99%

Economic Aspects of Physical Medicine and Rehabilitation for Health System

Ramova

2023

JIMR

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Introduction: The distribution of health money from the budget and health care fund is a special obligation of each country and its government to ensure a healthy population, which will be able to contribute to the economic growth. While the health cake is shared among the branches that give or save life, the percentage given for rehabilitation is very low. The aim of our research has been to represent economic benefits of involving rehabilitation in all stage of health treatment. Material and Method: For material, we used several publications by the WHO, and medical researchers about rehabilitation in the 21st century and its economic parameters for the cost of treatment of diseases. Results: In the treatment of diseases, PM&Reha can be included in all conditions of the disease, and in all diseases, from the Intensive Care unit to the return home or in a specialized facility for residence. The analysis of spent funds is made taking into account the number of hospital days, occurrence of complications and quality of life with necessary funds for extended care. In all analyses, if rehabilitation is included, the cost of treatment on an annual basis is lower, especially if conservative treatment, which costs less, is used instead of surgery. Discussion: PM&Reha is one of the oldest but also one of the most modern branches of medicine, which is developing exponentially due to the advancement of technology from software programs in rehabilitation to robotics in rehabilitation. The commitments of the WHO are until 2030, in all countries of the world, to have PM&Reha implemented in the health systems. From an economic point of view, it is difficult to carry out without international interventions with finances and education of health workers. Conclusions: The inclusion of PM&Reha in all levels of health care can reduce the costs of treating the underlying disease by reducing hospital days and preventing complications that will require additional costs for their treatment.

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Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures

Cited by 16 publications

References 38 publications

Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Identification of Risk Factors Associated With 30-Day Readmission of Patients Submitted to Anterior or Posterior Access Cervical Spine Surgery

Economic Aspects of Physical Medicine and Rehabilitation for Health System

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