Turnbull Zachary A, Tangel Virginia E, Goldstein Peter A
Anesthesiology, Weill Cornell, New York City, USA.
Cureus. 2022 Jul 15;14(7):e26875. doi: 10.7759/cureus.26875. eCollection 2022 Jul.
Anesthesiologists are increasingly encountering sicker patients that require potentially life-saving surgical interventions, and assess risk using the American Society of Anesthesiology Physical Status (ASA PS) classification system. Here, we examined long-term mortality along with hospital length of stay (LoS) and discharge disposition for survivors in ASA PS 5 and 5E patients.
Adult surgeries were extracted from New York-Presbyterian Hospital/Weill Cornell Medical Center's Electronic Medical Record (EMR) for cases between January 1, 2013 and December 31, 2017; outcomes were collected from EMRs and the Social Security Death Index Master File.
194,947 cases were identified. Mortality correlated with increasing ASA PS; the same trend was observed within both emergent and non-emergent sub-populations. Two hundred seventy-six cases were identified as 5/5E. This patient population had a higher rate of mortality at 30 days than at 48 hours (25.9% vs. 13.4%, respectively, p < 0.01); there was no difference between survivor functions at 30 or 90 days (p = 0.63, p = 0.09, respectively). Survivors within the 5 or 5E subpopulations did not have significantly different LoSs. Further, survivors after 90 days typically had a disposition of hospice, long-term facilities, inpatient rehabilitation, or self-discharged.
Mortality increases with increases in ASA PS classifications. There is no difference in outcomes for 5 vs 5E at 30- or 90-day postoperatively. Similarly, emergency status did not play a role in LoS. Most 5 or 5E patients are not discharged home but to another facility. These outcomes should be considered during the informed consent process in this high-risk surgical population.
麻醉医生越来越多地遇到病情较重、需要进行可能挽救生命的手术干预的患者，并使用美国麻醉医师协会身体状况（ASA PS）分类系统评估风险。在此，我们研究了ASA PS 5级和5E级患者的长期死亡率以及幸存者的住院时间（LoS）和出院处置情况。
从纽约长老会医院/威尔康奈尔医学中心的电子病历（EMR）中提取2013年1月1日至2017年12月31日期间的成人手术病例；结局数据从EMR和社会保障死亡指数主文件中收集。
共识别出194,947例病例。死亡率与ASA PS分级增加相关；在急诊和非急诊亚组中均观察到相同趋势。共识别出276例5/5E级病例。该患者群体30天的死亡率高于48小时（分别为25.9%和13.4%，p<0.01）；30天和90天的幸存者功能无差异（分别为p = 0.63，p = 0.09）。5级或5E级亚组中的幸存者住院时间无显著差异。此外，90天后的幸存者通常出院后前往临终关怀机构、长期护理机构、住院康复机构或自行出院。
死亡率随ASA PS分级增加而升高。术后30天或90天时，5级与5E级患者的结局无差异。同样，急诊状态对住院时间无影响。大多数5级或5E级患者不是出院回家，而是前往其他机构。在对这一高风险手术人群进行知情同意过程中应考虑这些结局。
