Key result
Discordant ASA classification between surgeons and anesthesiologists was associated with a significantly higher risk of 30-day mortality (OR 2.00) compared to concordant classification.
Why the study?
There is a paucity of clinical data on ASA classification concordance among healthcare providers, as well as the clinical factors and patient outcomes associated with discordant classification.
Does discordant ASA classification between surgeons and anesthesiologists correlate with adverse patient outcomes in patients undergoing elective surgery?
Cohort (n=46,284)
No
Does discordant ASA classification between surgeons and anesthesiologists correlate with adverse patient outcomes in patients undergoing elective surgery?
Odds Ratio: 2 (95% CI 1.52–2.62)
p-value: p=<0.0001
Discordant ASA classification between surgeons and anesthesiologists is associated with a significantly higher risk of 30-day mortality, 1-year mortality, and prolonged ICU admission, highlighting the need for cross-specialty review in discordant cases.
Discordant ASA classification was associated with higher mortality; leaves open whether cross-specialty review improves elective surgery outcomes.
The American Society of Anesthesiologists Physical Status Classification (ASA) is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA classification among healthcare providers. There is a paucity of studies using clinical data, and of clinical factors or patient outcomes associated with discordant classification. The study aims to assess ASA classification concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. This retrospective cohort study was conducted in a tertiary medical center on 46,284 consecutive patients undergoing elective surgery between January 2017 and December 2019. The ASA class showed moderate concordance (weighted Cohen's κ 0.53) between surgeons and anesthesiologists. We found significant associations between discordant classification and patient comorbidities, age and race. Patients with discordant classification had a higher risk of 30-day mortality (odds ratio (OR) 2.00, 95% confidence interval (CI) = 1.52-2.62, p < 0.0001), 1-year mortality (OR 1.53, 95% CI = 1.38-1.69, p < 0.0001), and Intensive Care Unit admission > 24 h (OR 1.69, 95% CI = 1.47-1.94, p < 0.0001). Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.
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Kwa et al. (2022) conducted a cohort in Elective surgery (n=46,284). Discordant ASA classification vs. Concordant ASA classification was evaluated on 30-day mortality (OR 2.00, 95% CI 1.52-2.62, p=<0.0001). Discordant ASA classification between surgeons and anesthesiologists was associated with a significantly higher risk of 30-day mortality (OR 2.00) compared to concordant classification.
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