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Does ASA Classification Correlate With Outcomes Following Open and Endovascular Aortic Aneurysm Repairs?
kuldeep singh, MD, Danny Yakoub, MD, Jonathan Schor, MD, Charles Sticco, DO, Qinghua Pu, MD, Jonathan Deitch, MD.
Staten Island University Hospital, staten island, NY, USA.
OBJECTIVES:
Recently published reports have shown that the American Society of Anesthesiology (ASA) classification system has limited ability to act as clinical indicators and predict adverse events. We undertook this study to compare and evaluate the applicability of ASA to prognosticate post-operative morbidity and mortality following open and endovascular aneurysm repairs.
METHODS:
We reviewed charts from January 1996 to September 2010 of all patients who underwent elective and urgent abdominal aneurysm procedures at SIUH were included for the study. Charts were reviewed, patient demographics, ASA classification and co-morbidities were recorded. Less than 30 days post operative mortality rates were analyzed along with postoperative complications.
RESULTS:
A total 233 patients (146 EVAR and 77 open) were included in the study. All were preformed under general anesthesia. The average age was 74.7 years for EVAR group and 67.7 for open. Number of patients with ASA classes 1, 2, 3 and 4 were 0, 3, 86 and 50 respectively in the EVAR group and 0, 0, 33 and 44 in the open group. There was no significant difference noted in age or sex between the two groups. Comorbidities in the EVAR vs. the open group included cardiac history (53% vs. 62%) renal insufficiency (10% vs. 19%) COPD (29% vs. 22%). EBL was significantly lower in the EVAR group (0.8 liters vs. 1.8 liters). 30 day mortality for EVAR vs. open repair (0.007% vs. 20%). Postoperative complication rate was significantly lower in EVAR group compared to the open group (21% vs. 59%); renal insufficiency (8.2% vs. 21%), respiratory failure (0.5% vs. 24.6%), and cardiac complications (2% vs. 25%). In the open group mortality and morbidity strongly correlated to the ASA class with higher mortality in ASA class 4 than class 3 patients (34% vs. 9%, p=0.006). With regards morbidity, in both the EVAR and the open groups, morbidity significantly increased with higher ASA class (EVAR group: 31% for ASA 3 and 56% for ASA 4, p <0.05) and (open group: 33% for ASA 3 and 100% for ASA 4, p <0.05).
CONCLUSIONS:
ASA scores were predicative of outcomes in patients undergoing both open AAA repair and EVAR especially in patients with ASA 3 and more. Better perioperative risk assessment tool is needed for patients undergoing both open and EVAR.
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