Deaths in Incorrectly Identified Low-Surgical-Risk Patients
Background The American Society of Anesthesiologists (ASA) physical classification system was developed for assessing anaesthetic risk, but is often also used to estimate surgical death risk. Patients with low ASA grades (ASA 1 or 2) are expected to have better surgical outcomes than patients with h...
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Veröffentlicht in: | World journal of surgery 2018-07, Vol.42 (7), p.1997-2000 |
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container_issue | 7 |
container_start_page | 1997 |
container_title | World journal of surgery |
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creator | Jones, C. R. McCulloch, G. A. J. Ludbrook, G. Babidge, W. J. Maddern, G. J. |
description | Background
The American Society of Anesthesiologists (ASA) physical classification system was developed for assessing anaesthetic risk, but is often also used to estimate surgical death risk. Patients with low ASA grades (ASA 1 or 2) are expected to have better surgical outcomes than patients with higher ASA grades (ASA ≥ 4). This study examined the course to death in patients classified as ASA 1 or 2 was examined, to investigate possible factors in unexpected deaths, in addition to evaluating the use of ASA grades by clinicians.
Methods
Patient data from the national surgical mortality audit of Australian hospitals were examined. The patient group was listed as ASA grade 1 or 2 by surgeons. Patients over 60 or under 20 were excluded in the final analysis, as were cases from New South Wales due to data not being available. A total of 357 cases were examined. Assessor summaries of the cases were examined, and ASA score reassessed to determine accuracy.
Results
More than 95% (
n
= 339) of cases listed as ASA 1 or 2 were found to have an incorrectly low grade, with 17.6% (
n
= 63) of cases listed as “expected” deaths.
Conclusion
ASA grades appear to be misunderstood in the reporting of patient surgical risk. Many patient summaries list patients with severe systemic disease or expected deaths as ASA 1 or 2, contrary to the intended use of this classification system. Improved education on the use of the ASA grading system would be beneficial to clinicians. |
doi_str_mv | 10.1007/s00268-017-4427-3 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1984752857</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1984336113</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4223-510a2bf7fdc82155b5426bda7949e9d50b5ea0081eaf0b3ddabe89c1cb99ec243</originalsourceid><addsrcrecordid>eNqFkEtLxDAUhYMoOj5-gBspuHETzauP4ErH18iA4gOXIU1vNdppx6RF5t-bWhURxFUu5DuHw4fQNiX7lJD0wBPCkgwTmmIhWIr5EhpRwRlmnPFlNCI8EeGmfA2te_9MApiQZBWtMcmkTEQyQocnoNsnH9k6mtSmcQ5MWy2iSQF1a0sLRTRt3vBt5x6t0RW-sf4lutatDd9-E62UuvKw9fluoPuz07vxBZ5enU_GR1NsBGMcx5RolpdpWZiM0TjOY8GSvNCpFBJkEZM8Bk1IRkGXJOdFoXPIpKEmlxIME3wD7Q29c9e8duBbNbPeQFXpGprOKyozkcYsi9OA7v5Cn5vO1WHdB8V5QikPFB0o4xrvHZRq7uxMu4WiRPVm1WBWBWGqN6v6zM5nc5fPoPhOfKkMgByAN1vB4v9G9XB5e3xGsoz35WzI-hCrH8H9mP3noncGeZMc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1984336113</pqid></control><display><type>article</type><title>Deaths in Incorrectly Identified Low-Surgical-Risk Patients</title><source>Wiley Online Library Journals Frontfile Complete</source><source>Springer Nature - Complete Springer Journals</source><creator>Jones, C. R. ; McCulloch, G. A. J. ; Ludbrook, G. ; Babidge, W. J. ; Maddern, G. J.</creator><creatorcontrib>Jones, C. R. ; McCulloch, G. A. J. ; Ludbrook, G. ; Babidge, W. J. ; Maddern, G. J.</creatorcontrib><description>Background
The American Society of Anesthesiologists (ASA) physical classification system was developed for assessing anaesthetic risk, but is often also used to estimate surgical death risk. Patients with low ASA grades (ASA 1 or 2) are expected to have better surgical outcomes than patients with higher ASA grades (ASA ≥ 4). This study examined the course to death in patients classified as ASA 1 or 2 was examined, to investigate possible factors in unexpected deaths, in addition to evaluating the use of ASA grades by clinicians.
Methods
Patient data from the national surgical mortality audit of Australian hospitals were examined. The patient group was listed as ASA grade 1 or 2 by surgeons. Patients over 60 or under 20 were excluded in the final analysis, as were cases from New South Wales due to data not being available. A total of 357 cases were examined. Assessor summaries of the cases were examined, and ASA score reassessed to determine accuracy.
Results
More than 95% (
n
= 339) of cases listed as ASA 1 or 2 were found to have an incorrectly low grade, with 17.6% (
n
= 63) of cases listed as “expected” deaths.
Conclusion
ASA grades appear to be misunderstood in the reporting of patient surgical risk. Many patient summaries list patients with severe systemic disease or expected deaths as ASA 1 or 2, contrary to the intended use of this classification system. Improved education on the use of the ASA grading system would be beneficial to clinicians.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-017-4427-3</identifier><identifier>PMID: 29299646</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Cardiac Surgery ; Classification ; Evaluation ; Fatalities ; General Surgery ; Medical personnel ; Medicine ; Medicine & Public Health ; Original Scientific Report ; Patients ; Quality ; Risk ; Summaries ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2018-07, Vol.42 (7), p.1997-2000</ispartof><rights>Société Internationale de Chirurgie 2018</rights><rights>2018 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>World Journal of Surgery is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4223-510a2bf7fdc82155b5426bda7949e9d50b5ea0081eaf0b3ddabe89c1cb99ec243</citedby><cites>FETCH-LOGICAL-c4223-510a2bf7fdc82155b5426bda7949e9d50b5ea0081eaf0b3ddabe89c1cb99ec243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-017-4427-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-017-4427-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,41467,42536,45553,45554,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29299646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jones, C. R.</creatorcontrib><creatorcontrib>McCulloch, G. A. J.</creatorcontrib><creatorcontrib>Ludbrook, G.</creatorcontrib><creatorcontrib>Babidge, W. J.</creatorcontrib><creatorcontrib>Maddern, G. J.</creatorcontrib><title>Deaths in Incorrectly Identified Low-Surgical-Risk Patients</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
The American Society of Anesthesiologists (ASA) physical classification system was developed for assessing anaesthetic risk, but is often also used to estimate surgical death risk. Patients with low ASA grades (ASA 1 or 2) are expected to have better surgical outcomes than patients with higher ASA grades (ASA ≥ 4). This study examined the course to death in patients classified as ASA 1 or 2 was examined, to investigate possible factors in unexpected deaths, in addition to evaluating the use of ASA grades by clinicians.
Methods
Patient data from the national surgical mortality audit of Australian hospitals were examined. The patient group was listed as ASA grade 1 or 2 by surgeons. Patients over 60 or under 20 were excluded in the final analysis, as were cases from New South Wales due to data not being available. A total of 357 cases were examined. Assessor summaries of the cases were examined, and ASA score reassessed to determine accuracy.
Results
More than 95% (
n
= 339) of cases listed as ASA 1 or 2 were found to have an incorrectly low grade, with 17.6% (
n
= 63) of cases listed as “expected” deaths.
Conclusion
ASA grades appear to be misunderstood in the reporting of patient surgical risk. Many patient summaries list patients with severe systemic disease or expected deaths as ASA 1 or 2, contrary to the intended use of this classification system. Improved education on the use of the ASA grading system would be beneficial to clinicians.</description><subject>Abdominal Surgery</subject><subject>Cardiac Surgery</subject><subject>Classification</subject><subject>Evaluation</subject><subject>Fatalities</subject><subject>General Surgery</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Scientific Report</subject><subject>Patients</subject><subject>Quality</subject><subject>Risk</subject><subject>Summaries</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkEtLxDAUhYMoOj5-gBspuHETzauP4ErH18iA4gOXIU1vNdppx6RF5t-bWhURxFUu5DuHw4fQNiX7lJD0wBPCkgwTmmIhWIr5EhpRwRlmnPFlNCI8EeGmfA2te_9MApiQZBWtMcmkTEQyQocnoNsnH9k6mtSmcQ5MWy2iSQF1a0sLRTRt3vBt5x6t0RW-sf4lutatDd9-E62UuvKw9fluoPuz07vxBZ5enU_GR1NsBGMcx5RolpdpWZiM0TjOY8GSvNCpFBJkEZM8Bk1IRkGXJOdFoXPIpKEmlxIME3wD7Q29c9e8duBbNbPeQFXpGprOKyozkcYsi9OA7v5Cn5vO1WHdB8V5QikPFB0o4xrvHZRq7uxMu4WiRPVm1WBWBWGqN6v6zM5nc5fPoPhOfKkMgByAN1vB4v9G9XB5e3xGsoz35WzI-hCrH8H9mP3noncGeZMc</recordid><startdate>201807</startdate><enddate>201807</enddate><creator>Jones, C. R.</creator><creator>McCulloch, G. A. J.</creator><creator>Ludbrook, G.</creator><creator>Babidge, W. J.</creator><creator>Maddern, G. J.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201807</creationdate><title>Deaths in Incorrectly Identified Low-Surgical-Risk Patients</title><author>Jones, C. R. ; McCulloch, G. A. J. ; Ludbrook, G. ; Babidge, W. J. ; Maddern, G. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4223-510a2bf7fdc82155b5426bda7949e9d50b5ea0081eaf0b3ddabe89c1cb99ec243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Cardiac Surgery</topic><topic>Classification</topic><topic>Evaluation</topic><topic>Fatalities</topic><topic>General Surgery</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Scientific Report</topic><topic>Patients</topic><topic>Quality</topic><topic>Risk</topic><topic>Summaries</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jones, C. R.</creatorcontrib><creatorcontrib>McCulloch, G. A. J.</creatorcontrib><creatorcontrib>Ludbrook, G.</creatorcontrib><creatorcontrib>Babidge, W. J.</creatorcontrib><creatorcontrib>Maddern, G. J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jones, C. R.</au><au>McCulloch, G. A. J.</au><au>Ludbrook, G.</au><au>Babidge, W. J.</au><au>Maddern, G. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deaths in Incorrectly Identified Low-Surgical-Risk Patients</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2018-07</date><risdate>2018</risdate><volume>42</volume><issue>7</issue><spage>1997</spage><epage>2000</epage><pages>1997-2000</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
The American Society of Anesthesiologists (ASA) physical classification system was developed for assessing anaesthetic risk, but is often also used to estimate surgical death risk. Patients with low ASA grades (ASA 1 or 2) are expected to have better surgical outcomes than patients with higher ASA grades (ASA ≥ 4). This study examined the course to death in patients classified as ASA 1 or 2 was examined, to investigate possible factors in unexpected deaths, in addition to evaluating the use of ASA grades by clinicians.
Methods
Patient data from the national surgical mortality audit of Australian hospitals were examined. The patient group was listed as ASA grade 1 or 2 by surgeons. Patients over 60 or under 20 were excluded in the final analysis, as were cases from New South Wales due to data not being available. A total of 357 cases were examined. Assessor summaries of the cases were examined, and ASA score reassessed to determine accuracy.
Results
More than 95% (
n
= 339) of cases listed as ASA 1 or 2 were found to have an incorrectly low grade, with 17.6% (
n
= 63) of cases listed as “expected” deaths.
Conclusion
ASA grades appear to be misunderstood in the reporting of patient surgical risk. Many patient summaries list patients with severe systemic disease or expected deaths as ASA 1 or 2, contrary to the intended use of this classification system. Improved education on the use of the ASA grading system would be beneficial to clinicians.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29299646</pmid><doi>10.1007/s00268-017-4427-3</doi><tpages>4</tpages></addata></record> |
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source | Wiley Online Library Journals Frontfile Complete; Springer Nature - Complete Springer Journals |
subjects | Abdominal Surgery Cardiac Surgery Classification Evaluation Fatalities General Surgery Medical personnel Medicine Medicine & Public Health Original Scientific Report Patients Quality Risk Summaries Surgery Thoracic Surgery Vascular Surgery |
title | Deaths in Incorrectly Identified Low-Surgical-Risk Patients |
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