Development and validation of a predictive model for American Society of Anesthesiologists Physical Status

Abstract

BackgroundThe American Society of Anesthesiologists Physical Status (ASA-PS) classification system was developed to categorize the fitness of patients before surgery. Increasingly, the ASA-PS has been applied to other uses including justification of inpatient admission. Our objectives were to develop and cross-validate a statistical model for predicting ASA-PS; and 2) assess the concurrent and predictive validity of the model by assessing associations between model-derived ASA-PS, observed ASA-PS, and a diverse set of 30-day outcomes.MethodsUsing the 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File, we developed and internally cross-validated multinomial regression models to predict ASA-PS using preoperative NSQIP data. Accuracy was assessed with C-Statistics and calibration plots. We assessed both concurrent and predictive validity of model-derived ASA-PS relative to observed ASA-PS and 30-day outcomes. To aid further research and use of the ASA-PS model, we implemented it into an online calculator.ResultsOf the 566,797 elective procedures in the final analytic dataset, 8.9% were ASA-PS 1, 48.9% were ASA-PS 2, 39.1% were ASA-PS 3, and 3.2% were ASA-PS 4. The accuracy of the 21-variable model to predict ASA-PS was C = 0.77 +/− 0.0025. The model-derived ASA-PS had stronger association with key indicators of preoperative status including comorbidities and higher BMI (concurrent validity) compared to observed ASA-PS, but less strong associations with postoperative complications (predictive validity). The online ASA-PS calculator may be accessed at https://s-spire-clintools.shinyapps.io/ASA_PS_Estimator/ConclusionsModel-derived ASA-PS better tracked key indicators of preoperative status compared to observed ASA-PS. The ability to have an electronically derived measure of ASA-PS can potentially be useful in research, quality measurement, and clinical applications.

Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported Outcomes After Medial Opening Wedge High Tibial Osteotomy

“…We evaluated descriptive and radiographic data, including age, sex, body mass index, American Society of Anesthesiologists grade, 28 pre- and postoperative hip-knee-ankle angle, pre- and postoperative WBL ratio, severity of OA with Kellgren-Lawrence (KL) grade, 21 and preoperative cartilage grade of the medial femoral condyle and medial tibial condyle during arthroscopic examination with the ICRS (International Cartilage Regeneration and Joint Preservation Society) classification. 18 The radiographic assessment was based on weightbearing full-length hip-to-ankle radiographs.…”

Effects of Intra-Articular Autologous Adipose Micrograft for the Treatment of Osteoarthritis in Dogs: A Prospective, Randomized, Controlled Study

“…Forty pet dogs affected by OA were referred by the Veterinary Teaching Hospital of the University of Camerino and enrolled in the study with their owners’ consent. Eligibility criteria included dogs aged 1 to 15 years, with no weight and sex restriction, belonging to the ASA 1–2 anesthetic risk class [ 38 ]; absent of comorbidity, pregnancy, or lactation; affected by lameness manifesting in one joint caused by OA; absent of OA in other joints of the same limb; belonging to radiographic grade OA between 1 and 4 (according to a modified Kellgren-Lawrence scale) [ 39 ]; and having not received anti-inflammatory drugs nor nutraceuticals in the 15 days prior to enrollment in the study. The entire cohort of patients who concluded the study had to follow a management therapy after receiving the treatment, limiting uncontrolled activities, favoring leashed walks, and avoiding nutraceuticals or anti-inflammatory drugs.…”

“…Moreover, in vivo studies have also reported interesting results, despite having their limits [ 33 , 34 ]. Over the past decade, research has brought new insights into the effects of ASCs, and new mechanical disintegration technologies promise rapid, ready-to- use stem cell collection under the principle of “minimum manipulation” [ 35 , 36 , 37 , 38 ].…”

Postoperative Complications and Outcome After Emergency Laparotomy: A Retrospective Study

“…The severity of the underlying comorbidities was assessed using the Charlson Comorbidity Index (CCI) [ 30 ]. The American Society of Anesthesiologists classification (ASA) was used to estimate the patient's preoperative risk [ 31 ]. Preoperative levels of albumin, leukocytes, platelets, hemoglobin and C-reactive protein (CRP) were obtained from the patients’ medical records.…”