Key result
ASA class IV was associated with an increased risk of 5-year mortality (HR 3.83; 95% CI 1.19-12.25; P=0.0239) and complications compared with ASA class I-II after thoracic endovascular aortic repair.
Why the study?
The collective effect of ASA classification adjusted for the SVS comorbidity grading system on long-term all-cause mortality, complications, and discharge disposition after TEVAR was unknown.
Does ASA physical status classification predict 5-year mortality and complications in patients undergoing TEVAR?
Cohort (n=217)
Yes
Does ASA physical status classification predict 5-year mortality and complications in patients undergoing TEVAR?
Hazard Ratio: 3.83 (95% CI 1.19–12.25)
p-value: p=0.0239
Procedural ASA class is an independent predictor of long-term mortality and complications in post-TEVAR patients, adding prognostic value beyond the SVS score.
ASA IV status may prompt closer post-TEVAR monitoring; leaves open whether it refines SVS-based risk stratification in prospective cohorts.
Use of the American Society of Anesthesiologists (ASA) physical status classification is important for periprocedural risk stratification. However, the collective effect after adjustment for the Society for Vascular Surgery (SVS) medical comorbidity grading system on long-term all-cause mortality, complications, and discharge disposition is unknown. We examined these associations in patients after thoracic endograft placement. Data from three thoracic endovascular aortic repair (TEVAR) trials through 5 years of follow-up were included. Patients with acute complicated type B dissection (n = 50), traumatic transection (n = 101), or descending thoracic aneurysm (n = 66) were analyzed. The patients were stratified into three groups according to the ASA class: I-II, III, and IV. Multivariable proportional hazards regression models were used to examine the effect of ASA class on 5-year mortality, complications, and rehospitalizations after adjustment for SVS risk score and potential confounders. The largest proportion of patients treated by TEVAR across the ASA groups (n = 217) was ASA IV (n = 97; 44.7%; P < .001), followed by ASA III (n = 83; 38.2%) and ASA I-II (n = 37; 17.1%). Among the ASA groups, the ASA I-II patients were, on average, 6 years younger than those with ASA III and 3 years older than those with ASA IV (ASA I-II: age, 54.3 ± 22.0 years; ASA III: age, 60.0 ± 19.7 years; ASA IV: age, 51.0 ± 18.4 years; P = .009). Multivariable adjusted 5-year outcome models showed that ASA class IV, independent of the SVS score, conferred an increased risk of mortality (hazard ratio [HR], 3.83; 95% confidence interval [CI], 1.19-12.25; P = .0239) and complications (HR, 4.53; 95% CI, 1.69-12.13; P = .0027) but not rehospitalization (HR, 1.84; 95% CI, 0.93-3.68; P = .0817) compared with ASA class I-II. Procedural ASA class is associated with long-term outcomes among post-TEVAR patients, independent of the SVS score. The ASA class and SVS score remain important to patient counseling and postoperative outcomes beyond the index operation.
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Bhamidipati et al. (2023) conducted a cohort in Thoracic aortic disease requiring TEVAR (n=217). ASA class IV vs. ASA class I-II was evaluated on 5-year mortality (HR 3.83, 95% CI 1.19-12.25, p=0.0239). ASA class IV was associated with an increased risk of 5-year mortality (HR 3.83; 95% CI 1.19-12.25; P=0.0239) and complications compared with ASA class I-II after thoracic endovascular aortic repair.
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