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Combining functional dependency and ASA III classification for risk stratification-predictors, risk factors, and outcomes following major surgery study (NCT02626546)
Karolinska University Hospital, Huddinge, Sweden.
Karolinska University Hospital, Huddinge, Sweden.
Örebro University, School of Medical Sciences.
Karolinska University Hospital, Solna Periooperative Medicine and Intensive Care, Sweden.
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, 1011-1011 p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: In elderly reclassification of ASA3 class by functional dependency improved prediction of postoperative mortality. We hypothesized that such a reclassification could improve the risk prediction of adverse outcomes also following high risk surgery.

Method: We analyzed data collected by the PROFS study in four Swedish academic hospitals. The inclusion criteria were: adults, ASA≥3, major or xmajor/complex surgery (UK surgical severity coding). ASA 3 patients were reclassified into ASA 3a (functionally independent) and 3b (functionally dependent). The adverse outcomes were postoperative complications (yes/no) screened by Postoperative Morbidity Survey (days 3, 7, 10) and mortality (30-day). Complications graded ≥2 by Clavien-Dindo classification were considered. The predictive value of reclassification was analyzed by logistic regression models.

Results: Between 2015 Nov2th and 2016 Feb19th 1089 patients were include; 13 were excluded (violation of inclusion criteria), 3 were lost to follow-up and 1073 were analyzed. ASA 3b (vs ASA 3a) patients had higher risk for mortality and for postoperative complications at days 7 and 10. ASA 4 (vs ASA 3) patients had higher risk of all adverse outcomes (Table 1). When age was added in the regression model ASA 3b patients still had higher risk for postoperative complications at day 10, but the significance disappeared when also urgency was added.

Conclusion: The loss of significance by adding urgency in the model might be attributed to the dominance of urgent procedures in ASA3b and ASA4 groups. Reclassification of ASA 3 patients by dependency is recommended, as it may predict adverse outcomes and support clinical judgment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017. Vol. 61, no 8, 1011-1011 p.
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-63376DOI: 10.1111/aas.12941ISI: 000407231100088OAI: oai:DiVA.org:oru-63376DiVA: diva2:1166127
Conference
34th Congress of the Scandinavian Society of Anesthesiology and Intensive Care Medicine, Malmö, Sweden, September 6-8, 2017
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2017-12-14Bibliographically approved

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Ahlstrand, Rebecca

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