Department of Surgery, Northwestern University, Chicago, IL, USA.
Department of Anesthesiology, Northwestern University, Chicago, IL, USA.
Int J Surg. 2015 Jun;18:184-90. doi: 10.1016/j.ijsu.2015.04.079. Epub 2015 Apr 30.
The American Society of Anesthesiologists Physical Status classification system (ASA PS) is a method of characterizing patient operative risk on a scale of 1-5, where 1 is normal health and 5 is moribund. Every anesthesiologist is trained in this measure, and it is performed before every procedure in which a patient undergoes anesthesia. We measured the independent predictive value of ASA-PS for complications and mortality in the ACS-NSQIP database by multivariate regression. We conducted analogous regressions after standardizing ASA-PS to control for interprocedural variations in risk in the overall model and sub-analyses by surgical specialty and the most common procedures.
For 2,297,629 cases (2005-2012; median age 55, min = 16, max > 90 [90 and above are coded as 90+]), at increasing levels of ASA-PS (2-5), odds ratios (OR's) from 2.05 to 63.25 (complications, p < 0.001) and 5.77-2011.92 (mortality, p < 0.001) were observed, with non-overlapping 95% confidence intervals. Standardization of ASA-PS (OR = 1.426 [per standard deviation above the mean ASA-PS per procedure], p < .001) and subgroup analyses yielded similar results.
ASA PS was not only found to be associated with increased morbidity and mortality, but independently predictive when controlling for other comorbidities. Even after standardization based on procedure type, increases in ASA predicted significant increases in complication rates for morbidity and mortality post-operatively.
ASA PS has strong, independent associations with post-operative medical complications and mortality across procedures. This capability, along with its simplicity, makes it a valuable prognostic metric.
美国麻醉医师协会身体状况分类系统（ASA PS）是一种衡量患者手术风险的方法，范围从 1 到 5，其中 1 表示健康状况正常，5 表示生命垂危。每位麻醉医师都接受过这种方法的培训，并且在每位接受麻醉的患者进行手术前都会进行评估。我们通过多元回归测量了 ASA-PS 在 ACS-NSQIP 数据库中对并发症和死亡率的独立预测价值。我们在标准化 ASA-PS 后进行了类似的回归，以控制整个模型和按手术专业和最常见手术进行的亚分析中的手术间风险变化。
对于 2,297,629 例病例（2005-2012 年；中位数年龄 55 岁，最小 16 岁，最大>90 岁[90 岁及以上的患者编码为 90+]），随着 ASA-PS 水平的升高（2-5），并发症的比值比（OR）从 2.05 到 63.25（p < 0.001），死亡率的 OR 从 5.77 到 2011.92（p < 0.001），置信区间无重叠。ASA-PS 的标准化（OR = 1.426[每例手术 ASA-PS 均值标准差以上]，p < 0.001）和亚组分析得出了类似的结果。
ASA PS 不仅与发病率和死亡率增加相关，而且在控制其他合并症时具有独立的预测价值。即使基于手术类型进行标准化后，ASA 的增加也预示着术后发病率和死亡率的并发症发生率显著增加。
ASA PS 与手术过程中的术后医疗并发症和死亡率具有很强的独立关联。这种能力，加上其简单性，使其成为一种有价值的预后指标。
