National Surgical Quality Improvement Program (NSQIP) Risk Factors Can Be Used to Validate American Society of Anesthesiologists Physical Status Classification (ASA PS) Levels

Objective:The purpose of this study was to determine the relationship between the American Society of Anesthesiologists’ Physical Status (ASA PS) classifications and the other National Surgical Quality Improvement Program (NSQIP) preoperative risk factors. Background:The ASA PS has been shown to predict morbidity and mortality in surgical patients but is inconsistently applied and clinically imprecise. It is desirable to have a method for validating ASA PS classification levels. Methods:The NSQIP preoperative risk factors, including ASA PS, were recorded from a random sample of 5878 surgical patients on 6 services between October 1, 2001 and September 30, 2003 at the University of Kentucky Medical Center. Mortality, morbidity, costs, and length of stay were obtained and compared across ASA PS levels. The ability of 1) ASA PS alone, 2) the other NSQIP risk factors, and, 3) all factors combined to predict outcomes was analyzed. A model using the other NSQIP risk factors was developed to predict ASA PS. Results:ASA PS alone was a strong predictor of outcomes (P < 0.01). However, the other NSQIP risk factors were better predictors as a group. There was significant interdependence between the ASA PS and the other NSQIP risk factors. Predictions of ASA PS using the other factors showed strong agreement with the anesthesiologists’ assignments. Conclusions:The NSQIP risk factors other than ASA PS can and should be used to validate ASA PS classifications.

[1]  K. Hammermeister,et al.  Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1998, Journal of the American College of Surgeons.

[2]  W HUEGIN,et al.  [THE ROLE OF ANESTHESIA IN SURGICAL MORTALITY]. , 1965, Klinische Medizin; osterreichische Zeitschrift fur wissenschaftliche und praktische Medizin.

[3]  E. Spitznagel,et al.  ASA Physical Status Classifications: A Study of Consistency of Ratings , 1978, Anesthesiology.

[4]  W. Owens,et al.  American Society of Anesthesiologists Physical Status Classification System in not a risk classification system. , 2001, Anesthesiology.

[5]  R. Figlin,et al.  Use of American Society of Anesthesiologists physical status classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma. , 2004, Urology.

[6]  M. Irwin,et al.  The ASA Physical Status Classification: Inter-observer Consistency , 2002, Anaesthesia and intensive care.

[7]  P. Bacchetti,et al.  Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. I. Long-Term Survival , 2003, Anesthesia and analgesia.

[8]  D. Schroeder,et al.  Risk Factors for Clinically Relevant Pulmonary Embolism and Deep Venous Thrombosis in Patients Undergoing Primary Hip or Knee Arthroplasty , 2003, Anesthesiology.

[9]  G. Scambia,et al.  Perioperative Morbidity and Mortality in Elderly Gynecological Oncological Patients (≥70 Years) by the American Society of Anesthesiologists Physical Status Classes , 2004, Annals of Surgical Oncology.

[10]  F. Grover,et al.  Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. , 1997, Journal of the American College of Surgeons.

[11]  W. Henderson,et al.  Preoperative Risk Factors and Surgical Complexity Are More Predictive of Costs Than Postoperative Complications: A Case Study Using the National Surgical Quality Improvement Program (NSQIP) Database , 2005, Annals of surgery.

[12]  J. Lopez-Escamez,et al.  American Society of Anesthesiology classification may predict severe post-tonsillectomy haemorrhage in children. , 2003, The Journal of otolaryngology.

[13]  W. Henderson,et al.  The National Surgical Quality Improvement Program in Non-Veterans Administration Hospitals: Initial Demonstration of Feasibility , 2002, Annals of surgery.

[14]  Michael L. Johnson,et al.  Mortality After Noncardiac Surgery: Prediction From Administrative Versus Clinical Data , 2005, Medical care.

[15]  Min P. Kim,et al.  Pulmonary resection in octogenarians with stage I nonsmall cell lung cancer: a 22-year experience. , 2004, The Annals of thoracic surgery.

[16]  Meyer Saklad,et al.  GRADING OF PATIENTS FOR SURGICAL PROCEDURES , 1941 .

[17]  J. Hanley,et al.  A method of comparing the areas under receiver operating characteristic curves derived from the same cases. , 1983, Radiology.

[18]  P. Lawler,et al.  An assessment of the consistency of ASA physical status classification allocation , 1995, Anaesthesia.

[19]  D. Reich,et al.  Predictors of Hypotension After Induction of General Anesthesia , 2005, Anesthesia and analgesia.

[20]  G. M. Woerlee.  ASA — Physical Status Classification , 1988 .

[21]  P. Bacchetti,et al.  Prognostic Significance of Postoperative In-Hospital Complications in Elderly Patients. I. Long-Term Survival , 2003, Anesthesia and analgesia.