This background review supports the American College of Physicians' clinical practice guideline on risk assessment for postoperative pulmonary complications after noncardiothoracic surgery.

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Preoperative pulmonary risk stratification for noncardiothoracic surgery: Systematic review for the American College of Physicians

From the Departments of Gastroenterology and Hepatology (D.L.C., E.A.J.R., K.H., M.J.B.), Surgery (D.J.G., M.A.B., O.R.B.), Radiology (Y.N., J.S., J.S.L.), and Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), Academic Medical Center, Amsterdam. Address reprint requests to Dr. Cahen at the Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or

https://www.nejm.org/doi/pdf/10.1056/NEJMoa060610

Endoscopic versus Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis

Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.

American Society of Anaesthesiologists physical status classification

Background—Perioperative myocardial infarction or cardiac arrest is associated with significant morbidity and mortality. The Revised Cardiac Risk Index is currently the most commonly used cardiac r...

Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery

Natural history of chronic renal insufficiency after partial and radical nephrectomy

In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classification and perioperative risk factors, and postoperative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed a significant correlation (P

ASA classification and perioperative variables as predictors of postoperative outcome.

But: Correler certaines variables perioperatoires a la morbidite et a la mortalite dans le but d'essayer de determiner la valeur predictive de ces variables vis a vis du devenir d'un patient donne. Type d'etude: Prospective. Provenance : Hopital universitaire, Allemagne. Patients: Six mille trois cent quatre patients admis pour une intervention chirurgicale. Methodes: Receuil de la classe de la Societe Americaine d'Anesthesiologie (ASA), de l'âge, du sexe, de la duree, de la classe d'intervention (Hoehn), de l'existence d'une anemie, d'une hypertension, d'une bronchopneumopathie, d'un diabete sucre, d'une insuffisance renale, d'une maladie gastrointestinale grave, du type d'anesthesie, du caractere urgent ou non de l'intervention et de sa duree. Tous ces facteurs ont ete soumis a une analyse par regression logistique. Principaux criteres de jugement: Les odds ratios (OR), la sensibilite, la specificite, et les valeurs predictives positive et negative. Resultats: Parmi les 6304 patients etudies, 140 sont decedes en postoperatoire et 1432 ont eu une complication non mortelle. La variable qui a eu le plus d'influence sur le risque de complications postoperatoires etait la classe ASA (ASA 4, OR 4,2, et ASA 3, OR 2,2), suivie de la gravite de l'intervention (OR 1,86). Des suites simples etaient correctement predites dans 96% des cas, mais la survenu de complications etaient correctment predite dans seulement 16% des cas. La valeur predictive positive etait 57% et la valeur predictive negative de 80%. Conclusions : Bien qu'un grand nombre de variables aient ete prises en consideration nous n'avons pas ete capables de predire avec une quelconque fiabilite le risque de complications chez un patient donne.

H Stützer

Papers

ASA classification and perioperative variables as predictors of postoperative outcome.

Risk factors, complications, and outcome in surgery: a multivariate analysis.