NDLI: The association between ASA status and other risk stratification models on postoperative intensive care unit outcomes.

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The association between ASA status and other risk stratification models on postoperative intensive care unit outcomes.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lupei, Monica I. Chipman, Jeffrey G. Beilman, Gregory J. Oancea, S. Cristina Konia, Mojca R.
Description	Author Affiliation: Lupei MI ( From the *Anesthesiology Critical Care Medicine Department, Northwestern University Feinberg School of Medicine, Chicago, Illinois)
Abstract	BACKGROUND: There is limited medical literature investigating the association between perioperative risk stratification methods and surgical intensive care unit (SICU) outcomes. Our hypothesis contends that routine assessments such as higher ASA physical status classification, surgical risk as defined by American College of Cardiology/American Heart Association guidelines, and simplified Revised Cardiac Index (SRCI) can reliably be associated with SICU outcomes. METHODS: We performed a chart review of all patients 18 years or older admitted to the SICU between October 1, 2010, and March 1, 2011. We collected demographic and preoperative clinical data: age, sex, ASA physical status class, surgical risk, and SRCI. Outcome data included our primary end point, SICU length of stay, and secondary end points: mechanical ventilation and vasopressor treatment duration, number of acquired organ dysfunctions (NOD), readmission to the intensive care unit (ICU) within 7 days, SICU mortality, and 30-day mortality. Regression analysis and nonparametric tests were used, and P < 0.05 was considered significant. RESULTS: We screened 239 patients and included 220 patients in the study. The patients' mean age was 58 ± 16 years. There were 32% emergent surgery and 5% readmissions to the SICU within 7 days. The SICU mortality and the 30-day mortality were 3.2%. There was a significant difference between SICU length of stay (2.9 ± 2.1 vs 5.9 ± 7.4, P = 0.007), mechanical ventilation (0.9 ± 2.0 vs 3.4 ± 6.8, P = 0.01), and NOD (0 [0-2] vs 1 [0-5], P < 0.001) based on ASA physical status class (≤ 2 vs ≥ 3). Outcomes significantly associated with ASA physical status class after adjusting for confounders were: SICU length of stay (incidence rate ratio [IRR] = 1.79, 95% confidence interval [CI], 1.35-2.39, P < 0.001), mechanical ventilation (IRR = 2.57, 95% CI, 1.69-3.92, P < 0.001), vasopressor treatment (IRR = 3.57, 95% CI, 1.84-6. 94, P < 0.001), NOD (IRR = 1.71, 95% CI, 1.46-1.99, P < 0.001), and readmission to ICU (odds ratio = 3.39, 95% CI, 1.04-11.09, P = 0.04). We found significant association between surgery risk and NOD (IRR = 1.56, 95% CI, 1.29-1.89, P < 0.001, and adjusted IRR = 1.31, 95% CI, 1.05-1.64, P = 0.02). SRCI was not significantly associated with SICU outcomes. CONCLUSIONS: Our study revealed that ASA physical status class is associated with increased SICU length of stay, mechanical ventilation, vasopressor treatment duration, NOD, readmission to ICU, and surgery risk is associated with NOD.
File Format	HTM / HTML
ISSN	00032999
Issue Number	5
Volume Number	118
e-ISSN	15267598
Journal	Anesthesia & Analgesia
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2014-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Anesthesiology Intensive Care Units Postoperative Care Methods Risk Assessment Adult Aged Anesthesia Recovery Period Anesthesia, General Critical Care Female Hospital Mortality Humans Length Of Stay Male Middle Aged Postoperative Complications Epidemiology Retrospective Studies Treatment Outcome Journal Article Observational Study
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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