ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients
| Autor: | John Di Capua, Joung-Heon Kim, Kevin Phan, Samuel K. Cho, James Dowdell, Jun S. Kim, Parth Kothari, Sulaiman Somani, Nathan J. Lee |
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| Rok vydání: | 2017 |
| Předmět: |
030222 orthopedics
medicine.medical_specialty complications business.industry Original Articles risk stratification outcomes Surgery 03 medical and health sciences 0302 clinical medicine ASA class Risk stratification Retrospective analysis Spinal deformity Medicine Orthopedics and Sports Medicine Neurology (clinical) Complication business American Society of Anesthesiologists adult spinal deformity surgery 030217 neurology & neurosurgery American society of anesthesiologists |
| Zdroj: | Global Spine Journal |
| ISSN: | 2192-5690 2192-5682 |
| Popis: | Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery. |
| Databáze: | OpenAIRE |
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