Is the ASA Classification Universal?

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

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Factors Associated with Respiratory Support after Cesarean Hysterectomy

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.08.12679 ◽

2021 ◽

Vol 104 (8) ◽

pp. 1347-1353

Keyword(s):

Mechanical Ventilation ◽

Hospital Stay ◽

Hospital Length Of Stay ◽

Respiratory Support ◽

Blood Components ◽

Factors Associated ◽

Cesarean Hysterectomy ◽

Asa Classification ◽

The Relationship ◽

Postoperative Mechanical Ventilation

Background: Cesarean hysterectomy is a major operation that causes massive hemorrhage and larger fluid resuscitation. Thus, postoperative mechanical ventilation support is required in some patients, involving longer hospital stay and high cost of hospital care. Objective: To find the predictive factors for postoperative respiratory support in pregnant women underwent cesarean hysterectomy. Materials and Methods: A retrospective review of patients underwent cesarean hysterectomy between January 2014 and June 2019 was conducted. Patient characteristics, anesthetic records and hospital length of stay were reviewed. The relationship between factors and postoperative mechanical ventilator (PMV) was also analyzed. Results: A total of 180 patients were included in the present study, wherein, 64 patients (35%) required PMV and 30 patients (16%) needed postoperative oxygen support. Multivariable logistic regression was used to identify the relationship between PMV and the associated factors. The authors found the American Society of Anesthesiologists (ASA) classification and the volume of intraoperative blood components replacement (packed red blood cells [PRC] and fresh frozen plasma [FFP]) were significantly related to PMV: ASA3 16.51 (95% CI 1.89 to 144.33), ASA4 183.25 (95% CI 2.92 to 11,500.65), p=0.003; PRC 1.0028 (95% CI 1.0008 to 1.0047), p=0.001; FFP 1.0022 (95% CI 1.0000 to 1.0043), p=0.029, respectively. Conclusion: Postoperative mechanical ventilation was found in one-third of the cesarean hysterectomy patients and associated with ICU admission along with increased in post-operative length of hospital stay. The ASA classification and intraoperative volume of blood components replacement were significantly associated with PMV. Factors associated significantly with respiratory support were ASA classification and duration surgery. Keywords: Factors associated; Respiratory support; Cesarean hysterectomy

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Risk factors for deep surgical site infection following thoracolumbar spinal surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19479 ◽

2020 ◽

Vol 32 (2) ◽

pp. 292-301 ◽

Cited By ~ 5

Author(s):

Hansen Deng ◽

Andrew K. Chan ◽

Simon G. Ammanuel ◽

Alvin Y. Chan ◽

Taemin Oh ◽

...

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spine Surgery ◽

Thoracolumbar Spine ◽

Hospital Length Of Stay ◽

Site Infection ◽

Asa Classification ◽

Estimated Blood Loss ◽

History Of ◽

The Mean

OBJECTIVESurgical site infection (SSI) following spine surgery causes major morbidity and greatly impedes functional recovery. In the modern era of advanced operative techniques and improved perioperative care, SSI remains a problematic complication that may be reduced with institutional practices. The objectives of this study were to 1) characterize the SSI rate and microbial etiology following spine surgery for various thoracolumbar diseases, and 2) identify risk factors that were associated with SSI despite current perioperative management.METHODSAll patients treated with thoracic or lumbar spine operations on the neurosurgery service at the University of California, San Francisco from April 2012 to April 2016 were formally reviewed for SSI using the National Healthcare Safety Network (NHSN) guidelines. Preoperative risk variables included age, sex, BMI, smoking, diabetes mellitus (DM), coronary artery disease (CAD), ambulatory status, history of malignancy, use of preoperative chlorhexidine gluconate (CHG) showers, and the American Society of Anesthesiologists (ASA) classification. Operative variables included surgical pathology, resident involvement, spine level and surgical technique, instrumentation, antibiotic and steroid use, estimated blood loss (EBL), and operative time. Multivariable logistic regression was used to evaluate predictors for SSI. Odds ratios and 95% confidence intervals were reported.RESULTSIn total, 2252 consecutive patients underwent thoracolumbar spine surgery. The mean patient age was 58.6 ± 13.8 years and 49.6% were male. The mean hospital length of stay was 6.6 ± 7.4 days. Sixty percent of patients had degenerative conditions, and 51.9% underwent fusions. Sixty percent of patients utilized presurgery CHG showers. The mean operative duration was 3.7 ± 2 hours, and the mean EBL was 467 ± 829 ml. Compared to nonfusion patients, fusion patients were older (mean 60.1 ± 12.7 vs 57.1 ± 14.7 years, p < 0.001), were more likely to have an ASA classification > II (48.0% vs 36.0%, p < 0.001), and experienced longer operative times (252.3 ± 120.9 minutes vs 191.1 ± 110.2 minutes, p < 0.001). Eleven patients had deep SSI (0.49%), and the most common causative organisms were methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus. Patients with CAD (p = 0.003) or DM (p = 0.050), and those who were male (p = 0.006), were predictors of increased odds of SSI, and presurgery CHG showers (p = 0.001) were associated with decreased odds of SSI.CONCLUSIONSThis institutional experience over a 4-year period revealed that the overall rate of SSI by the NHSN criteria was low at 0.49% following thoracolumbar surgery. This was attributable to the implementation of presurgery optimization, and intraoperative and postoperative measures to prevent SSI across the authors’ institution. Despite prevention measures, having a history of CAD or DM, and being male, were risk factors associated with increased SSI, and presurgery CHG shower utilization decreased SSI risk in patients.

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ASA Physical Status Classification and Complications Following Facial Fracture Repair

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211059599 ◽

2021 ◽

pp. 000348942110595

Author(s):

Parisorn Thepmankorn ◽

Chris B. Choi ◽

Sean Z. Haimowitz ◽

Aksha Parray ◽

Jordon G. Grube ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Fracture Repair ◽

Site Infection ◽

Class Iii ◽

Facial Fracture ◽

Asa Classification ◽

Physical Status Classification ◽

Deep Surgical Site Infection ◽

Status Classification

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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Risk Factors for Opioid Use Following Anterior Cruciate Ligament Reconstruction (ACLR) in a Cohort of 21,202 ACLR

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00257 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0025

Author(s):

Anita G. Rao ◽

Heather A. Prentice ◽

Priscilla Hannah Chan ◽

Liz W. Paxton ◽

Tadashi Ted Funahashi ◽

...

Keyword(s):

Risk Factors ◽

Substance Abuse ◽

Pulmonary Disease ◽

Chronic Pulmonary Disease ◽

Meniscal Injury ◽

Opioid Use ◽

Opioid Medication ◽

Factors Associated ◽

Asa Classification

Objectives: The misuse of opioid medication has contributed to a significant national crisis affecting public health, as well as patient morbidity and medical costs. We sought to determine baseline opioid utilization in patients undergoing ACLR and examine demographic, patient characteristics, and medical factors associated with postoperative opioid utilization. Methods: Primary elective ACLR were identified using an integrated healthcare system’s ACLR registry (January 2005-January 2015). Patients with cancer or those who had other knee surgery in the preceding year were excluded. We studied the effect of preoperative and intraoperative risks factors on number of dispensed opioid medication prescriptions (Rx) in the early (0-90 days) and late (91-360 days) postoperative periods using logit regression. Risk factors studied included: number of opioid Rx in preceding year, age, gender, race, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), activity at the time of injury, time from injury to ACLR, concomitant procedure or injury, medical comorbidities, and opioid-use comorbidities. Results: Of 21202 ACLR from 20813 patients, 25.5% used at least 1 opioid Rx in the one-year preoperative period. 17.7% and 2.7% used ≥2 opioid Rx in the early and late recovery periods, respectively. The risk factors associated with greater opioid Rx in both the early and late periods included: preoperative opioid use, age >20 years, ASA classification of ≥3, other activity at the time of injury, repaired cartilage injury, chronic pulmonary disease, and substance abuse. Risk factors associated with opioid Rx use during the early period only included: other race, acute ACL injury, repaired meniscal injury, multi-ligament injury, and dementia/psychoses. Risk factors associated with greater opioid Rx during the late period included: female gender, BMI >25 kg/m2, motor vehicle accident as the mechanism of injury, and hypertension. Conclusion: We identified several risk factors for postoperative opioid usage after ACLR. The strongest predictors of postoperative prescription opioid usage after ACLR included preoperative opioid use, increasing age, ASA classification of 3 or more, other activity at the time of injury, repaired meniscal injury, cartilage repair, chronic pulmonary disease, and substance abuse. Awareness of risk factors for postoperative opioid usage may encourage more targeted utilization of opioids in pain management. Surgeons may consider additional support or referral to a pain specialist for patients with these risk factors. [Figure: see text]

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Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study

World Journal of Surgery ◽

10.1007/s00268-019-05256-9 ◽

2019 ◽

Vol 44 (3) ◽

pp. 730-740 ◽

Cited By ~ 1

Author(s):

Femke Nawijn ◽

Svenna H.W.L. Verhiel ◽

Kiera N. Lunn ◽

Kyle R. Eberlin ◽

Falco Hietbrink ◽

...

Keyword(s):

Risk Factor ◽

Soft Tissue ◽

Mortality Rate ◽

Upper Extremity ◽

Base Deficit ◽

Amputation Rate ◽

Soft Tissue Infections ◽

Factors Associated ◽

Asa Classification ◽

Necrotizing Soft Tissue Infections

Abstract Background It is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30-days and amputation in patients with upper extremity NSTIs. Methods A retrospective study over a 20-year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30-day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs. Results Within 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64–52.31) and a base deficit of 3 meq/L or greater (OR 10.53, 95% CI 1.14–96.98). The independent risk factor for amputation was a NSTI of the non-dominant arm (OR 3.78, 95% CI 1.07–13.35). Length of hospital stay was 15 (IQR 9–21) days. Conclusion Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss.

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Prognostic Risk Factors for Complications Associated with Below the Knee Amputations

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00370 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0037

Author(s):

Jason Ni ◽

Eric Lukosius ◽

Kaitlin Saloky ◽

Kempland Walley ◽

Leanne Ludwick ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Charlson Comorbidity Index ◽

High Rate ◽

Tourniquet Time ◽

Ambulatory Status ◽

Asa Classification ◽

Below The Knee ◽

Comorbidity Index ◽

Prognostic Risk Factors

Category: Other Introduction/Purpose: Below the knee amputation (BKA) is an effective surgical procedure for individuals with severe injury or infection to their lower extremities. However, patients who receive these procedures are subject to significant morbidity and a high rate of postoperative complications due to the presence of multiple concomitant comorbidities. Despite the wide practice of this intervention, prognostic risk factors aiding in predicting surgical outcomes in these patients are poorly understood. The purpose of this study is to evaluate risk factors that may contribute to the outcomes of BKA procedures. Methods: The clinical and radiographic outcomes for 89 patients ages 19-90 who underwent BKA were retrospectively evaluated from 2012-2017. Postoperative complications of mortality, infection, and reoperation were evaluated with patient and surgical variables. Patient variables included: age, ambulatory status, obesity, diabetes, HbA1C2 levels, neuropathy, smoking, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) classification. Surgical variables evaluated included: presence of pre-op infection, pre-op ambulatory status, tourniquet time, tourniquet pressure, and usage of prophylactic antibiotics. Results: Of the patients evaluated there was an overall complication rate of 49% (44/89) and a mortality rate of 19% (17/89). Patients with diabetes (p=.035), a greater score on the Charlson Comorbidity Index (p=.001), and an ASA classification =3 (p=.005) were associated with a greater risk of mortality. Operative values (i.e. tourniquet time, tourniquet pressure etc.) did not affect patient mortality rates in a significant way, but there was a higher incidence of complications (i.e. mortality, post-op infections, and reoperations) with patients with pre-operative infections. Conclusion: Diabetes, a higher CCI score and a greater ASA value were found to be significant predictors of patient mortality after BKA (p<0.05). Future perioperative optimization in these patients identified as high risk may improve patient outcomes in the future.

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MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS

Innovation in Aging ◽

10.1093/geroni/igz038.2531 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S686-S686

Author(s):

Jung-Yeon Choi ◽

Kwang-il Kim ◽

Hee-won Jung ◽

Cheol-Ho Kim ◽

Sung-Bum Kang ◽

...

Keyword(s):

Postoperative Complication ◽

Grip Strength ◽

Gait Speed ◽

Surgical Patients ◽

Secondary Outcome ◽

P Value ◽

Asa Classification ◽

Increased Risk ◽

Prognostic Utility ◽

Frailty Score

Abstract Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p < 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value < 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p < 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.

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American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps

Otolaryngology ◽

10.1177/0194599819832812 ◽

2019 ◽

Vol 161 (1) ◽

pp. 91-97 ◽

Cited By ~ 1

Author(s):

Luke T. Small ◽

Madison Lampkin ◽

Emre Vural ◽

Mauricio A. Moreno

Keyword(s):

Intensive Care Unit ◽

High Risk ◽

Risk Group ◽

Free Flaps ◽

High Risk Group ◽

Medical Complication ◽

Complication Rates ◽

Asa Classification ◽

American Society ◽

American Society Of Anesthesiologists

ObjectiveTo evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway.Study DesignCase series with chart review.SettingSingle tertiary care academic institution.Subjects and MethodsData were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248).ResultsTotal medical complication rates ( P = .012) were mildly increased in the high-risk group, as a result of increased minor—not major—medical complication rates ( P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group ( P = .024). All other outcomes were not statistically different between the cohorts.ConclusionThe ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.

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