What question did this study set out to answer?

To assess the relationship between ASA Physical Status (ASA PS) designation and 48-hour postoperative mortality in elective and emergent surgery, comparing contemporary outcomes with a 1970 historical benchmark.

October 20, 2016Perioperative MedicineOpen Access

Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort

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Why the study?

Does ASA Physical Status designation associate with 48-hour postoperative mortality in a contemporary cohort compared to a historical cohort?

Population

732,704 consecutive patient encounters undergoing elective and emergent procedures between 2009 and 2014…

Comparison

ASA Physical Status designation and emergent vs… vs Historical cohort from 1970 of adult men at US…

Design

Cohort

Follow-up

48 hours

Authors

THThomas J. HopkinsGeneral Marble (Greece)KRKarthik RaghunathanDuke University ABAtílio BarbeitoDuke University

Discussion

Member takes

Implication

Supports ASA PS for risk stratification; leaves open why emergent mortality has not improved since 1970.

Key Points

To assess the relationship between ASA Physical Status (ASA PS) designation and 48-hour postoperative mortality in elective and emergent surgery, comparing contemporary outcomes with a 1970 historical benchmark.
Analyzed prospectively collected registry data from the Quantum™ Clinical Navigation System database on 732,704 consecutive patient encounters (2009–2014) across 233 anesthetizing locations at 19 facilities in two US states.
Tabulated 48-hour mortality against ASA PS classes (1–5) with or without emergency ('E') designations, constructing a matched subset of 242,103 adult males to evaluate historical changes against data published by Vacanti et al. in 1970.
In the contemporary cohort, 48-hour mortality showed a significant upward trend with increasing ASA PS designation (p < 0.0001) and was markedly higher for emergent versus elective procedures (1.27% vs. 0.03%, p < 0.0001).
Among adult males, contemporary 48-hour elective surgical mortality was significantly lower than historical 1970 rates (0.05% vs. 0.24%, p < 0.0001), whereas emergent surgical mortality was 1.88% compared to 1.22% in 1970 (p < 0.0001).

Structured PICO

Does ASA Physical Status designation associate with 48-hour postoperative mortality in a contemporary cohort compared to a historical cohort?

Population

732,704 consecutive patient encounters undergoing elective and emergent procedures between 2009 and 2014 across 19 facilities in two US states. A comparison cohort of 242,103 adult male patients was created to match a historical cohort.

Intervention

ASA Physical Status (ASA PS) designation (1-5) and emergent vs elective surgery status

Comparator

Historical cohort from 1970 (Vacanti et al.) of adult men at US naval hospitals

Outcome

Death within 48 h of procedurehard clinical

Increasing ASA Physical Status remains significantly associated with 48-hour postoperative mortality, and while elective surgery mortality has decreased since 1970, emergent surgery mortality has not.

Cite This Study

Hopkins et al. (2016) studied this question.

synapsesocial.com/papers/6a8408bd121b098de683d418 https://doi.org/10.1186/s13741-016-0054-z

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Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider