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
Hauptverfasser: Jones, C. R., McCulloch, G. A. J., Ludbrook, G., Babidge, W. J., Maddern, G. J.
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container_end_page 2000
container_issue 7
container_start_page 1997
container_title World journal of surgery
container_volume 42
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
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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. 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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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