June 19, 2018Perioperative MedicineOpen Access

Clinical agreement in the American Society of Anesthesiologists physical status classification

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Elective total hip or total knee replacement (n=101). Intervention: ASA-PS classification by internal medicine provider vs. ASA-PS classification by anesthesia provider. Primary outcome: Agreement in ASA-PS classification between internal medicine and PAU providers (Kappa 0.170, 95% CI -0.001, 0.340, p=0.034).

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Key result

ASA-PS classification assignment showed significant disagreement between internal medicine and anesthesia providers (Kappa 0.170), but near-perfect agreement among anesthesia providers (Kappa 0.863).

Population

101 patients ≥ 65 years of age undergoing elective total hip or total knee replacements at a military…

Comparison

ASA-PS classification assigned by internal… vs ASA-PS classification assigned by Pre-Anesthesia…

Design

Cohort

Authors

KKKayla M. KnufBrooke Army Medical Center CMChristopher V. MaaniBrooke Army Medical Center ACAdrienne CummingsBrooke Army Medical Center

Discussion

Member takes

Implication

Inter-specialty ASA-PS disagreement may affect preoperative risk estimates; leaves open whether standardized training improves consistency.

Study Design

Type

Observational (n=101)

Multicenter

Structured PICO

Population

101 patients ≥ 65 years of age undergoing elective total hip or total knee replacements at a military treatment facility.

Intervention

ASA-PS classification assigned by internal medicine clinic provider

Comparator

ASA-PS classification assigned by Pre-Anesthesia Unit (PAU) clinic provider and day of surgery (DOS) anesthesia provider

Outcome

Agreement in ASA-PS classification between internal medicine providers, PAU providers, and DOS anesthesia providers

Main Result

Effect estimate: Kappa 0.170 (95% CI -0.001, 0.340)

p-value: p=0.034

There is significant inter-specialty disagreement in ASA-PS classification between internal medicine and anesthesia providers, highlighting the need for standardized training to ensure accurate preoperative risk stratification.

Limitations

Retrospective nature
Unable to collect full data sets as the ASA-PS class was not measured in a large subset
ASA-PS classes 1 and 5 were not represented
Conducted at a military treatment facility (MTF) which may have resulted in less patient variability
Retrospective design
Incomplete data sets leading to exclusion of 76 records
ASA-PS classes 1 and 5 not represented
Single-center military treatment facility population may not generalize to civilian populations

Cite This Study

Knuf et al. (2018) conducted an observational in Elective total hip or total knee replacement (n=101). ASA-PS classification by internal medicine provider vs. ASA-PS classification by anesthesia provider was evaluated on Agreement in ASA-PS classification between internal medicine and PAU providers (Kappa 0.170, 95% CI -0.001, 0.340, p=0.034). ASA-PS classification assignment showed significant disagreement between internal medicine and anesthesia providers (Kappa 0.170), but near-perfect agreement among anesthesia providers (Kappa 0.863).

synapsesocial.com/papers/6a160ca09a0ac003cd6b4f39 https://doi.org/10.1186/s13741-018-0094-7

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June 19, 2018Perioperative MedicineOpen Access

Clinical agreement in the American Society of Anesthesiologists physical status classification

View Full Paper

Ask AI

Bookmark

Key result

ASA-PS classification assignment showed significant disagreement between internal medicine and anesthesia providers (Kappa 0.170), but near-perfect agreement among anesthesia providers (Kappa 0.863).

Population

101 patients ≥ 65 years of age undergoing elective total hip or total knee replacements at a military…

Comparison

ASA-PS classification assigned by internal… vs ASA-PS classification assigned by Pre-Anesthesia…

Design

Cohort

Authors

KKKayla M. KnufBrooke Army Medical Center CMChristopher V. MaaniBrooke Army Medical Center ACAdrienne CummingsBrooke Army Medical Center

Discussion

Member takes

Implication

Inter-specialty ASA-PS disagreement may affect preoperative risk estimates; leaves open whether standardized training improves consistency.

Study Design

Type

Observational (n=101)

Multicenter

Structured PICO

Population

101 patients ≥ 65 years of age undergoing elective total hip or total knee replacements at a military treatment facility.

Intervention

ASA-PS classification assigned by internal medicine clinic provider

Comparator

ASA-PS classification assigned by Pre-Anesthesia Unit (PAU) clinic provider and day of surgery (DOS) anesthesia provider

Outcome

Agreement in ASA-PS classification between internal medicine providers, PAU providers, and DOS anesthesia providers

Main Result

Effect estimate: Kappa 0.170 (95% CI -0.001, 0.340)

p-value: p=0.034

Limitations

Retrospective nature
Unable to collect full data sets as the ASA-PS class was not measured in a large subset
ASA-PS classes 1 and 5 were not represented
Conducted at a military treatment facility (MTF) which may have resulted in less patient variability
Retrospective design
Incomplete data sets leading to exclusion of 76 records
ASA-PS classes 1 and 5 not represented
Single-center military treatment facility population may not generalize to civilian populations

Cite This Study

synapsesocial.com/papers/6a160ca09a0ac003cd6b4f39 https://doi.org/10.1186/s13741-018-0094-7

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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