Background
ASA physical status classification | Definition | Examples, including, but not limited to |
---|---|---|
ASA I | A normal healthy patient | Healthy, non-smoking, no or minimal alcohol use |
ASA II | A patient with mild systemic disease | Mild diseases only without substantive functional limitations. Examples include (but not limited to) current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, and mild lung disease |
ASA III | A patient with severe systemic disease | Substantive functional limitations: one or more moderate to severe diseases. Examples include (but not limited to) poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥ 40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, and history (> 3 months) of MI, CVA, TIA, or CAD/stents |
ASA IV | A patient with severe systemic disease that is a constant threat to life | Examples include (but not limited to) recent (< 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, and ARD or ESRD not undergoing regularly scheduled dialysis |
ASA V | A moribund patient who is not expected to survive without the operation | Examples include (but not limited to) ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleeding with mass effect, and ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction |
ASA VI | A declared brain-dead patient whose organs are being removed for donor purposes |
Methods
Results
Demographics | All cases % (no.) | Mortalities % (no.) |
p value | |
---|---|---|---|---|
Age | 56.5 ± 0.47 | 71 ± 3 | < 0.001 | |
Gender | Male | 45.3% (573) | 57.6% (19) | 0.215 |
Female | 54.7% (691) | 42.4% (14) | ||
Race | White | 82.2% (1039) | 84.8% (28) | 0.896 |
Black | 10.4% (132) | 12.1% (4) | ||
American Indian | 1.1% (14) | 0.0% (0) | ||
Asian | 1.1% (14) | 0.0% (0) | ||
Unknown | 5.1% (65) | 3.0% (1) | ||
Hispanic ethnicity | 3.4% (43) | 0.0% (0) | 0.624 | |
Emergency | 12.1% (153) | 70.0% (23) | < 0.001 | |
Transfer | 12.1% (153) | 60.6% (20) | < 0.001 | |
Surgery type | General surgery | 41.0% (518) | 51.5% (17) | 0.046 |
Breast/endocrine | 21.5% (272) | 0.0% (0) | ||
Vascular | 18.4% (233) | 27.3% (9) | ||
Colorectal | 10.1% (128) | 15.2% (5) | ||
Hepatobiliary | 5.8% (73) | 6.1% (2) | ||
Bariatric | 3.2% (40) | 0.0% (0) |
NSQIP variables | All cases % (no.) | Mortalities % (no.) |
p value | |
---|---|---|---|---|
Functional status | Independent | 96.2% (1216) | 87.9% (29) | 0.013 |
Partially dependent | 3.2% (40) | 12.1% (4) | ||
Totally dependent | 0.6% (8) | 0.0% (0) | ||
Wound class | Clean | 55.0% (695) | 33.3% (11) | 0.003 |
Clean/contaminated | 27.3% (345) | 27.3% (9) | ||
Contaminated | 7.9% (100) | 12.1% (4) | ||
Dirty | 9.8% (124) | 27.3% (9) | ||
Steroid | 4.1% (52) | 12.1% (4) | 0.050 | |
Ascites | 0.5% (6) | 9.1% (3) | 0.001 | |
Sepsis | SIRS | 6.6% (84) | 21.2% (7) | < 0.001 |
Sepsis | 4.7% (59) | 18.2% (6) | ||
Septic shock | 1.0% (13) | 24.2% (8) | ||
Ventilator | 1.3% (16) | 27.3% (9) | < 0.001 | |
Disseminated cancer | 4.2% (53) | 24.2% (8) | < 0.001 | |
Diabetes | 20.1% (254) | 39.4% (13) | 0.014 | |
Hypertension | 48.7% (616) | 75.8% (25) | 0.002 | |
CHF | 0.6% (8) | 3.0% (1) | 0.208 | |
Dyspnea | At rest | 0.6% (7) | 3.0% (1) | 0.069 |
Moderate exertion | 8.4% (106) | 15.2% (5) | ||
None | 91.1% (1151) | 81.8% (27) | ||
Smoker | 31.3% (396) | 39.4% (13) | 0.039 | |
COPD | 7.5% (95) | 27.3% (9) | < 0.001 | |
Dialysis | 2.4% (30) | 6.1% (2) | 0.194 | |
ARF | 0.6% (8) | 6.1% (2) | 0.025 | |
BMI | 30.4 ± 0.24 | 27.5 ± 1.54 | 0.054 |
2014 mortalities | |||
Patient | Charted ASA | Recalculated ASA | Reason for change |
1 | 4 | 5 | Ruptured abdominal aortic aneurysm with intraoperative cardiac arrest |
2 | 3E | 5E | Superior mesenteric artery occlusion with bowel ischemia |
3 | Not recorded | 5 | Perforated colon with sepsis. Moribund |
4 | 4 | 3 | Reviewer used subsequent cases after complications instead of index case |
5 | 4 | 3 | Several severe systemic comorbidities (poorly controlled diabetes, chronic obstructive pulmonary disease, asthma), but none were a constant threat to life |
6 | 3 | 4 | Active congestive heart failure |
2014 all cases sample | |||
Patient | Charted ASA | Recalculated ASA | Reason for change |
1 | 3 | 2 | Controlled hypertension and asthma, otherwise healthy. Localized Hurthle cell cancer |
2 | 3 | 4 | Stroke within 3 months |
3 | 3 | 4 | Myocardial infarction within 3 months with 14% left ventricular ejection fraction on echocardiogram |
4 | 3E | 4E | Perforated small bowel with sepsis |
5 | 3E | 2E | Infected thigh hematoma, but not septic. Remote history of supraventricular tachycardia, but otherwise healthy and not on medications |
6 | 3E | 4E | Perforated viscus with sepsis |
7 | 3E | 4E | Bowel necrosis present on colonoscopy prior to operation |
2014 emergency cases sample | |||
Patient | Charted ASA | Recalculated ASA | Reason for change |
1 | 3E | 4E | Perforated viscus |
2 | 3E | 5E | Ruptured abdominal aortic aneurysm |
3 | 3E | 4E | Perforated diverticulitis |
4 | 3E | 4E | Perforated small bowel with sepsis |
5 | 3E | 4E | Ongoing crescendo transient ischemic attacks |
6 | 3E | 2E | Appendicitis, not septic and no major medical problems |