American Society of Anaesthesiologists physical status classification
TL;DR: The current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification are reviewed.
Abstract: 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.
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TL;DR: A low complication rate was seen when using TXA as a blood conservation modality during primary THA and TKA with less aggressive thromboprophylactic regimens such as aspirin alone and dose-adjusted warfarin.
Abstract: Background
The use of antifibrinolytic medications in hip and knee arthroplasty reduces intraoperative blood loss and decreases transfusion rates postoperatively. Tranexamic acid (TXA) specifically has not been associated with increased thromboembolic (TE) complications, but concerns remain about the risk of symptomatic TE events, particularly when less aggressive chemical prophylaxis methods such as aspirin alone are chosen.
177 citations
TL;DR: Routine use of tranexamic acid TA was associated with lower mean direct hospital total costs after primary total hip and knee arthroplasty as the increase in pharmacy costs was more than offset by cost savings in other categories.
Abstract: Tranexamic acid (TA) has been shown to reduce perioperative blood loss and blood transfusion. While concern remains about the cost of antifibrinolytic medication, we hypothesized that routine use of tranexamic acid would result in lower direct hospital total cost by decreasing costs associated with blood transfusion, laboratory testing, and room & board. Patients with an American Society of Anesthesiologists (ASA) class II or less undergoing primary total hip or knee arthroplasty at a single institution during 2007–2008 were retrospectively reviewed. The estimated mean direct hospital total cost, operating room, blood/lab, room & board, and pharmacy costs were compared between patients who did and did not receive TA. The study population included 1018 patients, and 580 patients received TA. The mean direct total cost of hospitalization with and without TA was $15,099 and $15,978 ( P P
109 citations
TL;DR: The identified preoperative and intraoperative variables associated with extended LOS after elective posterior lumbar fusion may be helpful to clinicians for patient counseling and postoperative planning.
Abstract: Study Design
Retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2010 that included 1,861 patients who had undergone elective posterior lumbar fusion.
108 citations
TL;DR: Worse preoperative OKS, worse mental well-being, body mass index greater than 35 kg/m2, living in the most deprived areas, higher American Society of Anesthesiologists grade, presence of comorbidities, and history of previous knee surgery were associated with worse overall OKS over 10 years after surgery.
Abstract: Background This study aimed at identifying preoperative predictors of patient-reported outcomes after total knee arthroplasty (TKA) and at investigating their association with the outcomes over time. Methods We used data from 2080 patients from the Knee Arthroplasty Trial who received primary TKA in the United Kingdom between July 1999 and January 2003. The primary outcome measure was the Oxford knee score (OKS) collected annually over 10 years after TKA. Preoperative predictors included a range of patient characteristics and clinical conditions. Mixed-effects linear regression model analysis of repeated measurements was used to identify predictors of overall OKS, and pain and function subscale scores over 10 years, separately. Results Worse preoperative OKS, worse mental well-being, body mass index greater than 35 kg/m 2 , living in the most deprived areas, higher American Society of Anesthesiologists grade, presence of comorbidities, and history of previous knee surgery were associated with worse overall OKS over 10 years after surgery. The same predictors were identified for pain and function subscale scores, and for both long-term (10 years) and short-to-medium-term outcomes (1 and 5 years). However, fitted models explained more variations in function and shorter-term outcomes than in pain and longer-term outcomes, respectively. Conclusion The same predictors were identified for pain and functional outcomes over both short-to-medium term and long term after TKA. Within the factors identified, functional and shorter-term outcomes were more predictable than pain and longer-term outcomes, respectively. Regardless of their preoperative characteristics, on average, patients achieved substantial improvement in pain over time, although improvement for function was less prominent.
88 citations
Cites background from "American Society of Anaesthesiologi..."
...ASA grading system is a standard assessment of the patient’s general physical health before surgery [34]....
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TL;DR: Most of the included CDSS studies were associated with positive patient outcomes effects but with substantial differences regarding the clinical impact, most of the implemented algorithms were rule-based and reported input variables are shared as standardized models on a metadata repository.
83 citations
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TL;DR: The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.
Abstract: The American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by a questionnaire sent to 304 anesthesiologists. They were requested to classify ten hypothetical patients. Two hundred fifty-five (77.3 percent) responded to two mailings. The mean number of patients rated consistently was 5.9. Four patients elicited wide ranges of responses. Age, obesity, previous myocardial infarction, and anemia provoked controversy. There was no significant difference in responses from different regions of the country. Academic anesthesiologists rated a greater number identical than did those in private practice (P less than 0.01). There was no difference in ratings between those who used the classification for billing purposes and those who did not. The ASA Physical Status Classification is useful but suffers from a lack of scientific precision.
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...general assessment of illness severity.[1] While their...
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TL;DR: It is concluded that ASA physical status classification was a predictor of 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.
Abstract: 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
884 citations
488 citations
"American Society of Anaesthesiologi..." refers background in this paper
...Finally, Wolters and his colleagues examined the strength of association between ASA physical status classification and perioperative risk factors and postoperative outcome in a prospective study of 6301 surgical patients in a university hospital using univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model.[13] Univariate analysis showed a significant correlation (P < 0....
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