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Alam, A., A. Mukherjee, J. Xu, et al. "Validating the Newly Reported ASA Score." Journal of Heart and Lung Transplantation 38, no. 4 (2019): S379. http://dx.doi.org/10.1016/j.healun.2019.01.965.
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Michael, A., K. Eagland, and L. Doos. "ASA Score in hip fracture patients." European Geriatric Medicine 3 (September 2012): S50. http://dx.doi.org/10.1016/j.eurger.2012.07.059.
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Nouvellon, Emmanuel, and Jacques Ripart. "Faut-il encore croire au score ASA ?" Le Praticien en Anesthésie Réanimation 11, no. 3 (2007): 212–16. http://dx.doi.org/10.1016/s1279-7960(07)78608-4.
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Nouvellon, E., and J. Rippart. "Faut-il encore croire au score ASA ?" Le Praticien en Anesthésie Réanimation 11, no. 3 (2007): 243. http://dx.doi.org/10.1016/s1279-7960(07)78628-x.
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Lake, A. P., and E. G. Williams. "ASA classification and perioperative variables: graded anaesthesia score?" British Journal of Anaesthesia 78, no. 2 (1997): 228–29. http://dx.doi.org/10.1093/bja/78.2.228-a.
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Turan, Engin İhsan, Abdurrahman Engin Baydemir, Funda Gümüş Özcan, and Ayça Sultan Şahin. "Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction." Journal of Clinical Anesthesia 96 (September 2024): 111475. http://dx.doi.org/10.1016/j.jclinane.2024.111475.
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Thakore, Rachel V., Young M. Lee, Vasanth Sathiyakumar, William T. Obremskey, and Manish K. Sethi. "Geriatric Hip Fractures and Inpatient Services: Predicting Hospital Charges Using the ASA Score." Current Gerontology and Geriatrics Research 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/923717.
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Purpose.To determine if the American Society of Anesthesiologist (ASA) score can be used to predict hospital charges for inpatient services.Materials and Methods.A retrospective chart review was conducted at a level I trauma center on 547 patients over the age of 60 who presented with a hip fracture and required operative fixation. Hospital charges associated with inpatient and postoperative services were organized within six categories of care. Analysis of variance and a linear regression model were performed to compare preoperative ASA scores with charges and inpatient services.Results.Inpatient and postoperative charges and services were significantly associated with patients’ ASA scores. Patients with an ASA score of 4 had the highest average inpatient charges of services of $15,555, compared to $10,923 for patients with an ASA score of 2. Patients with an ASA score of 4 had an average of 45.3 hospital services compared to 24.1 for patients with a score of 2.Conclusions.A patient’s ASA score is associated with total and specific hospital charges related to inpatient services. The findings of this study will allow payers to identify the major cost drivers for inpatient services based on a hip fracture patient’s preoperative physical status.
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Riechelmann, H., A. Neagos, U. Netzer-Yilmaz, S. Gronau, M. Scheithauer, and M. G. Rockemann. "Der ASA-Score als Komorbiditätsindex bei Mundhöhlen- und Mundrachenkarzinomen." Laryngo-Rhino-Otologie 85, no. 02 (2006): 99–104. http://dx.doi.org/10.1055/s-2005-870291.
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Curatolo, Christopher, Andrew Goldberg, David Maerz, Hung-Mo Lin, Hardikkumar Shah, and Muoi Trinh. "ASA physical status assignment by non-anesthesia providers: Do surgeons consistently downgrade the ASA score preoperatively?" Journal of Clinical Anesthesia 38 (May 2017): 123–28. http://dx.doi.org/10.1016/j.jclinane.2017.02.002.
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Kastanis, G., A. Topalidou, K. Alpantaki, M. Rosiadis, and K. Balalis. "Is the ASA Score in Geriatric Hip Fractures a Predictive Factor for Complications and Readmission?" Scientifica 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/7096245.
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Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients’ health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were6.4±2.1days for the patients with ASA II,10.4±3.4days for the patients with ASA III, and13.5±4.4days for the patients with ASA IV. The patients with ASA II exhibited minor complications, while patients with ASA III presented cutaneous ulcer and respiratory dysfunction. Five patients with ASA IV had pulmonary embolism, two patients had myocardial infarction, and three patients died. The ASA score seems to have direct correlation with multiple factors, such as the hospitalization days, the severity of the complications, and the total hospitalization costs. The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.
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Turan, Engin İhsan, Abdurrahman Engin Baydemir, Ayça Sultan Şahin, and Funda Gümüş Özcan. "Clarifications and reflections on ASA score prediction using ChatGPT-4." Journal of Clinical Anesthesia 97 (October 2024): 111547. http://dx.doi.org/10.1016/j.jclinane.2024.111547.
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Bjorgul, Kristian, Wendy Novicoff, and Khaled J. Saleh. "Using ASA Score to Predict Mortality after Hip Fracture Surgery." Journal of Arthroplasty 25, no. 3 (2010): e45. http://dx.doi.org/10.1016/j.arth.2010.01.053.
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Karl, Alexandra. "Score for Wavelength. An Homage to Michael Snow." ASAP/Journal 4, no. 3 (2019): 510–16. http://dx.doi.org/10.1353/asa.2019.0035.
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Zhang, Chenghong, and Xinzhong Chen. "Letter to the editor, “Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction”." Journal of Clinical Anesthesia 98 (November 2024): 111571. http://dx.doi.org/10.1016/j.jclinane.2024.111571.
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Djaladat, Hooman, Adrian Stuart Fairey, Jie Cai, et al. "The impact of preoperative ASA and serum albumin on early complication and survival rate of patients undergoing radical cystectomy for bladder cancer." Journal of Clinical Oncology 30, no. 5_suppl (2012): 313. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.313.
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313 Background: American Society of Anesthesiologist (ASA) score is used to evaluate the physical status of patients before surgery. Serum albumin is also a known marker of nutritional status. We evaluated the impact of preoperative ASA score and serum albumin on early complication and survival of pts who underwent radical cystectomy for bladder cancer. Methods: 1,964 patients with bladder cancer underwent cystectomy between 1971 and 2008 at the USC. Preoperative serum albumin and ASA score were available in 1471 and 1140 patients respectively. Post cystectomy early complication was defined as any postoperative event leading to lengthening hospital stay or re-admission within 90 days of surgery. Recurrence free survival (RFS) and overall survival (OS) for these cohorts were reviewed. Results: The demographic data of pts based on their serum albumin and ASA score is presented in table 1. Median follow up was 12.4 years (0 - 36.6 yrs). Low serum albumin (<3.4 g/dL) and high ASA score (3 or 4) were associated with higher early complication rate (43% vs. 33%, p= 0.03 and 40% vs. 28%, p= 0.0001 respectively). In multivariable analysis, low serum albumin was an independent predictor of RFS (HR 1.35, 95% CI 1.00-1.81) and OS (HR 1.62, 95% CI 1.29-2.04). High ASA score was an independent predictor of OS (HR 1.45, 95% CI 1.13-1.85), but not RFS. Conclusions: Preoperative low serum albumin and high ASA score are independently predictive of post cystectomy decreased overall survival. Low serum albumin is also a risk factor for recurrence after cystectomy. These parameters potentially could be used in nomograms to predict postoperative prognosis in patients undergoing radical cystectomy. Demographic data in 1,471 and 1,140 patients who underwent cystectomy for bladder cancer based on preoperative serum albumin and ASA score, respectively. [Table: see text]
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Waskitojati Pamungkas, Akbar, Muhammad Hafiduddin, and Happy Nurhayati. "Hubungan Status Fisik (Asa) Dengan Waktu Pencapaian Bromage Score 2 Pada Pasien Spinal Anestesi Di Ruang Pemulihan." Profesi (Profesional Islam) : Media Publikasi Penelitian 21, no. 2 (2024): 88–94. http://dx.doi.org/10.26576/profesi.v21i2.213.
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AbstrakSpinal anestesi merupakan blok regional dengan menyuntikkan obat anestesike dalam ruang subarachnoid. Anestesi dapat berdampak pada sistem syarafpusat. Efek pada sistem syaraf pusat lainnya termasuk mengantuk, kepalaterasa ringan, gangguan visual dan pendengaran, dan kecemasan. Faktor-faktor yang mempengaruhi pemulihan motorik ekstermitas inferior pasienpasca anestesi spinal, adalah jenis dan dosis obat anestesi, penyebaran obat,efek vasokontriksi, lengkung tulang belakang, umur, jenis kelamin, obesitas,posisi operasi serta status fisik America Society of Anesthesiologist (ASA).Penelitian ini bertujuan untuk mengetahui hubungan status fisik AmericaSociety of Anesthesiologist (ASA) dengan waktu pencapaian bromage score 2pada pasien spinal anestesi di ruang pemulihan. Jenis penelitian ini adalahkuantitatif dengan metode observasional analitik. Jenis penelitian inimenggunakan desain penelitian korelasi analitik dengan pendekatancrossectional. Sampel yang digunakan sebanyak 30 sampel. Analisa datamenggunakan uji korelasi spearman. Hasil penelitian menunjukkan bahwakedua kelompok data tersebut memiliki hubungan karena nilai signifikansi pvalue= 0,000 yaitu kurang dari 0,05, artinya hubungan antara status fisik(ASA) dan waktu pencapaian bromage score 2 signifikan secara statistik.Kesimpulannya adalah terdapat hubungan status fisik (ASA) dengan waktupencapaian bromage score 2 dan semakin tinggi ASA maka semakin lamawaktu pencapaian bromage score 2.
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Grigorescu, Bianca-Liana, Irina Săplăcan, Marius Petrișor, Ioana Roxana Bordea, Raluca Fodor, and Alexandra Lazăr. "Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia—A Pilot Study." Medicina 57, no. 10 (2021): 1132. http://dx.doi.org/10.3390/medicina57101132.
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Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.
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Reponen, Elina, Miikka Korja, and Hanna Tuominen. "Simple Preoperative Patient-Reported Factors Predict Adverse Outcome After Elective Cranial Neurosurgery." Neurosurgery 83, no. 2 (2017): 197–202. http://dx.doi.org/10.1093/neuros/nyx385.
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Abstract BACKGROUND Patient-reported preoperative factors hold promise in improving the prediction of postoperative adverse events, but they have been poorly studied. OBJECTIVE To study the role of patient-reported factors in the preoperative risk stratification of elective craniotomy patients. METHODS A prospective, unselected cohort of 322 adult patients underwent elective craniotomy in Helsinki, Finland. We preoperatively recorded the American Society of Anesthesiologists (ASA) score, Helsinki ASA score, and 3 questionnaire-based patient-reported factors including overall health status, ability to climb 2 flights of stairs, and cognitive function (Test Your Memory test). Outcome measures comprised in-hospital major and overall morbidity. Receiver-operating characteristic curves served to calculate area under the curve (AUC) values for a composite score of patient-reported factors and both ASA scores with regard to outcomes. RESULTS In-hospital major and overall morbidity rate was 15.2%. Only preoperatively diminished cognitive function remained a significant predictor of major morbidity after multivariable logistic regression analysis (P &lt; .001, odds ratio 1.1, confidence interval 1.0-1.1). A composite score of our 3 patient-reported factors had a higher AUC (0.675) for major morbidity than original ASA score (0.543) or Helsinki ASA score (0.572). In elderly patients, the composite score had an AUC of 0.726 for major morbidity. CONCLUSION Preoperative patient-reported factors had higher sensitivity for detecting major morbidity compared to the ASA scores in this study. Particularly, the simple composite score seems to predict adverse outcomes in elective cranial surgery surprisingly well, especially in the elderly. These results are interesting and worth confirming in other centers.
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Adeyemi, Oluwaseun John, Ariana Meltzer-Bruhn, Garrett Esper, et al. "Crosswalk between Charlson Comorbidity Index and the American Society of Anesthesiologists Physical Status Score for Geriatric Trauma Assessment." Healthcare 11, no. 8 (2023): 1137. http://dx.doi.org/10.3390/healthcare11081137.
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The American Society of Anesthesiologists Physical Status (ASA-PS) grade better risk stratifies geriatric trauma patients, but it is only reported in patients scheduled for surgery. The Charlson Comorbidity Index (CCI), however, is available for all patients. This study aims to create a crosswalk from the CCI to ASA-PS. Geriatric trauma cases, aged 55 years and older with both ASA-PS and CCI values (N = 4223), were used for the analysis. We assessed the relationship between CCI and ASA-PS, adjusting for age, sex, marital status, and body mass index. We reported the predicted probabilities and the receiver operating characteristics. A CCI of zero was highly predictive of ASA-PS grade 1 or 2, and a CCI of 1 or higher was highly predictive of ASA-PS grade 3 or 4. Additionally, while a CCI of 3 predicted ASA-PS grade 4, a CCI of 4 and higher exhibited greater accuracy in predicting ASA-PS grade 4. We created a formula that may accurately situate a geriatric trauma patient in the appropriate ASA-PS grade after adjusting for age, sex, marital status, and body mass index. In conclusion, ASA-PS grades can be predicted from CCI, and this may aid in generating more predictive trauma models.
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Choi, Katherine J., Christopher H. Pham, Zachary J. Collier, et al. "5 The Predictive Capacity of ASA PS in Burn Patients." Journal of Burn Care & Research 41, Supplement_1 (2020): S6—S7. http://dx.doi.org/10.1093/jbcr/iraa024.009.
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Abstract Introduction The four main prognostic models used to determine risk of burn mortality are the revised Baux (rBaux), Belgian Outcome in Burn Injury (BOBI), Abbreviated Burn Severity Index (ABSI), and quick Sequential Organ Failure Assessment (qSOFA). These models fail to factor in medical comorbidities. The ASA PS (American Society of Anesthesiologists Physical Status) is a simple scale incorporating severity of traumatic injury with comorbidities, which strongly predicts mortality in surgical patients. The purpose of this study is to determine whether the ASA PS is an adequate adjunct to measure burn severity. Methods All adults admitted to an ABA verified burn center from January 2016 to April 2019 with TBSA ≥10% who underwent surgery were reviewed. Demographics (age, gender, TBSA, race, ASA PS), vital signs (GCS, blood pressure, respiratory rate), and outcome variables (length of stay [LOS], mechanical ventilation [MV] days, and complications) were evaluated. rBaux, BOBI, ABSI, and qSOFA scores were calculated. The primary outcome was in-hospital mortality. After descriptive statistical analysis, mortality associations of the models were assessed by determining odds ratios. Firth’s logistic regression and area under the receiver operator curves determined the predictive utility of the prognostic scores. Results Of the 183 patients who fit inclusion criteria, median age was 44 years (30–57), and the majority (70%) were male. Median TBSA was 20%, 65% (n=118) had full thickness burns, 14% (n=25) had inhalation injury, and mortality was 9% (n=17). rBaux score was the best predictor of mortality (AUC=.84), ICU LOS (R2=.04), and MV days (R2=.06). For every 10-point increase in rBaux score, there was a 1.7 times increase in mortality (OR=1.7, CI 1.4–2.3, p&lt; .00). The predicted ICU LOS increases from 2.8 to 31.4 days for the lowest and highest rBaux score quartiles. Compared to rBaux scores of 30–53, patients with scores of 54–70 had 4 times more MV days (CI 1.5–11, p&lt; .00). The ASA PS was slightly inferior to rBaux in predicting mortality (AUC=.72), although not statistically significant (p=0.1). As ASA PS score went from I/II to III, III to IV, and IV to V/VI; mortality increased by 2.8 (OR=2.8, CI 1.5–5.5, p&lt; .00). Conclusions rBaux is the best predictor of mortality, ICU LOS, and MV days although ASA PS also predicts mortality. Future studies should determine the combined predictive ability of ASA PS and rBaux. Applicability of Research to Practice rBaux and ASA PS scores can be used to determine risk of mortality in burn patients.
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Balkaya, Ayşe Neslihan, and Asiye Demirel. "Prediction of pulmonary complications following spine surgery: The ASA and ARISCAT risk indexes." Journal of Clinical Medicine of Kazakhstan 19, no. 6 (2022): 32–37. http://dx.doi.org/10.23950/jcmk/12663.
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<b>Objective</b><b>:</b> We aimed to evaluate the effectiveness of predicting postoperative pulmonary complications (PPCs) following spine surgery, comparing American Society of Anesthesiologist (ASA) and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk scoring systems.<br /> <b>Material and methods: </b>We reviewed 377 patients aged≥18 years who had undergone vertebral surgery. Demographic data, comorbidities, ASA classification, body mass index, ARISCAT risk score, pulmonary complications developing with in the postoperative 1st month were assessed.<br /> <b>Results:</b> A total of 377 patients, 221 (58.6%) women and 156 (41.4%) men, mean age of 59±11.8 years were evaluated. Out of the 377 patients, 73 (19.4%) patients were ASA I, 235 (62.3%) patients were ASA II, 69 (18.3%) patients were ASA III, and the mean ARISCAT score was 22.51±8.38. In the postoperative period, PPC was identified in 30 (8%) patients, with atelectasis in 15 (4%), pneumothorax in 4 (1.1%), pneumonia in 4 (1.1%), respiratory failure in 4 (1.1%), bronchospasm in 2 (0.5%) patients, and pulmonary embolism in 1 (0.3%) patient. There was a statistically significant correlation between the presence of PPC and ASA score, and between the presence of PPC and the ARISCAT levels (p=0.000, p=0.000). The incidence of PPC increased with increasing ASA scores. The ARISCAT scores were higher in patients who developed PPC. The hospital stay of patients with PPCs were longer than other patients (p=0.000).<br /> <b>Conclusion: </b>In our study, in which ASA classification and ARISCAT risk index were compared as a means to predict PPC, both scores were found to be effective.
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Koranne, Aboli, K. G. Byakodi, Vasant Teggimani, Vijay V. Kamat, and Abhijith Hiregoudar. "A Comparative Study between Peptic Ulcer Perforation Score, Mannheim Peritonitis Index, ASA Score, and Jabalpur Score in Predicting the Mortality in Perforated Peptic Ulcers." Surgery Journal 08, no. 03 (2022): e162-e168. http://dx.doi.org/10.1055/s-0042-1743526.
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Abstract Introduction Peptic ulcer disease continues to be a major public health in most developing countries despite the advances in medical management. The incidence of perforations remains high and has the highest mortality rate of any complication of ulcer disease. Risk stratification of cases will lead to better preoperative management and efficient utilization of intensive care unit resources. The purpose of the present study is to compare different existing scoring systems and identify the most accurate predictor of mortality in perforated peptic ulcer (PPU) cases. Materials and Methods This is an observational study conducted in Karnataka Institute of Medical Sciences, Hubli, India. All cases of PPU disease admitted from December 2017 to August 2019 who were treated surgically were included in the study. Demographic data were collected and peptic ulcer perforation (PULP) score, Mannheim peritonitis index (MPI), American Society of Anesthesiologists (ASA) score, and Jabalpur score (JS) were calculated for individual patient and compared. The patient was followed up during the postoperative period. Observation A total of 45 patients were included in the study with a mean age of 42.5 years. Most of the patients presented with 24 hours of the onset of symptoms. Nonsteroidal anti-inflammatory drug use was noted in 8.9% patients, and steroid use was present in 2.2% patients. Of the 45 patients, 7 deaths were reported. Between the various scoring systems, the MPI and JS were better predictors of mortality with a p-value of <0.001 and 0.007, respectively. In contrast, the PULP and ASA scores had p-value not statistically significant. However, the PULP score was a better predictor of postoperative complication with a p-value of 0.047. Conclusion Of the four scoring systems validated, the MPI and JS were better predictors of mortality in the given population. PULP score is a better predictor of postoperative complications in the present study.
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Choi, Jung-Yeon, Kwang-il Kim, Hee-won Jung, et al. "MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS." Innovation in Aging 3, Supplement_1 (2019): S686. http://dx.doi.org/10.1093/geroni/igz038.2531.
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Abstract Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p &lt; 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value &lt; 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p &lt; 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.
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Karnina, Resiana, Nandya Satyaning Rahayu, and Muhammad Faruk. "Factors influencing Bromage score in post-spinal anesthesia patients." Bali Medical Journal 11, no. 3 (2022): 1146–50. https://doi.org/10.15562/bmj.v11i3.3435.
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Introduction: Bromage score is used in assessing patients post-spinal anesthesia while the patient is in the recovery room. Patients can be transferred to the treatment room from the recovery room if they have achieved a Bromage score of <2. Post-anesthesia recovery is significant to pay attention to because if there are obstacles in post-anesthesia recovery, it will cause some complications that the patient needs a long time in the treatment room. Several factors may be related to Bromage score, American Society of Anesthesiology (ASA) physical status, age, gender, the dose of local anesthetic drugs, and other factors. Methods: This type of research Observational Analytics used secondary data with a cross-sectional study design with 327 participants. Data analysis using coefficient contingency correlation test. Results: The majority of 315 (96.6%) patients achieved a Bromage score of 1, with the highest number of patients aged (12-45 years). Patients with ASA physical status 1, a male and spinal anesthetic with a dose of Bupivacaine 10 mg – 15.5 mg achieved the most Bromage score 1. There was a significant relationship between gender and Bromage score in patients after spinal anesthesia, p-value = 0.048 (p-value < 0.05). Conclusion: There is a significant relationship between sex and the Bromage score, and there is no significant relationship between ASA physical status, age, and local anesthetic dose with the Bromage score.
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Story, D. A., M. Fink, K. Leslie, et al. "Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients." Anaesthesia and Intensive Care 37, no. 3 (2009): 392–98. http://dx.doi.org/10.1177/0310057x0903700310.
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We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. We included 1012 patients and the 30-day mortality was 6%. The three preoperative factors and risk scores were (“three A's”): 1) age, years: 70 to 79=1, 80 to 89=3, 90+=6; 2) ASA physical status: ASA I or II=0, ASA III=3, ASA IV=6, ASA V=15; and 3) preoperative albumin <30 g/l=2.5. The three postoperative factors and risk scores were (“three I's”) 1) unplanned intensive care unit admission =4.0; 2) systemic inflammation =3; and 3) acute renal impairment=2.5. Scores and mortality were: <5=1%, 5 to 9.5=7% and ≥10=26%. We also used a preliminary validation cohort of 256 patients from a regional hospital. The area under the receiver operating characteristic curve (C-statistic) for the derivation cohort was 0.80 (95% CI 0.74 to 0.86) similar to the validation C-statistic: 0.79 (95% CI 0.70 to 0.88), P=0.88. The Hosmer-Lemeshow test (P=0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.
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Aliyafih, Muhammad, Sindu Sintara, Merisdawati Merisdawati, Mokhtar Jamil, and M. Rodli. "HUBUNGAN STATUS FISIK AMERICAN SOCIETY OF ANESTHESIOLOGIST TERHADAP WAKTU PENCAPAIAN BROMAGE SCORE 2 DI RUANG PEMULIHAN PADA PASIEN SECTIO CAESAREA DENGAN SPINAL ANESTESI." Jurnal Kesehatan Hesti Wira Sakti 11, no. 2 (2023): 252–57. http://dx.doi.org/10.47794/jkhws.v11i2.579.
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ABSTRAK 
 Pendahuluan: Spinal anestesi pada operasi sectio caesarea sebelumnya dilakukan evaluasi pra anestesi dengan penilaian ASA (American Society of Anesthesiologist) untuk memastikan pelaksanaan perawatan anestesi yang aman pada pasien. Tujuan penelitian untuk mengetahui hubungan status fisik ASA dengan waktu pencapaian Bromage score 2 di ruang pemulihan pada pasien sectio caesarea dengan spinal anestesi di RS Intan Medika Lamongan. Metode: Penelitian Observational-analytic menggunakan metode Cross-sectional dengan total sampel 73 responden. Pengumpulan data dilakukan dengan observasi langsung dan analisis statitistik menggunakan analisa univariat dan uji korelasi Spearman’s. Hasil: Status fisik ASA memiliki hubungan positif dengan lama waktu pencapaian Bromage score 2 pada pasien sectio caesaria dengan anestesi spinal (p = 0.000 < 0.05; r = 0,527). Kesimpulan: Status fisik ASA berhubungan dengan lama waktu pencapaian Bromage score 2 pasien sectio caesaria dengan spinal anestesi di Intan Medika Lamongan.
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Thakur, Jaya Prakash, Resham Bahadur Rana, and Abhay Pokharel. "Ketamine with Midazolam and Ketamine alone as oral premedication in children: a randomized trial." Journal of Society of Anesthesiologists of Nepal 4, no. 2 (2018): 66–73. http://dx.doi.org/10.3126/jsan.v4i2.21206.
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Background: Fear of operation, injections, physicians and peculiar operation theatre environment where children are separated from their parents prior to anesthesia invariably produce traumatic experiences in tender mind of young children. Midazolam and Ketamine are useful for oral premedication in children to allay anxiety, allow separation from parents and to ensure smooth induction.Methodology: It was a prospective, randomized, double-blinded and comparative study conducted in 80 children of ASA I and II aged 1-6years undergoing elective ophthalmological procedures under general anesthesia. Children were randomized and divided into two groups, K received 4mg/kg of Ketamine and MK received 0.2mg/kg of Midazolam+2mg/kg of Ketamine peroral. Sedation level, ease of parental separation and ease of mask acceptance were evaluated within 20-30 minutes on a 4-point scale. The time to achieve modified Aldrete score of ≥9 was also noted.Results: Two groups were identical regarding age, sex, weight and ASA status. In sedation score, 31(77.5%) children in group K and 35(87.5%) children in group MK were awake, calm and quite (score3)(p=0.50). In parental separation score, 34(85%) children in group MK and 25(62.5%) children in group K have good separation, awake and calm (score2) (p=0.04). In mask acceptance score, 34(85%) children in group MK and 17(42.5%) children in group K were calm, awake, cooperative, accepting Mask (score1)(p=0.001). Time of recovery in group K was 17.92}6.50min whereas in group MK was 17.80}4.059min(p=0.91).Conclusion: Ketamine 4mg/kg and combination of Midazolam 0.2mg/kg with Ketamine 2mg/kg are equally effective but low dose combination is safe and superior. Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, Page: 66-73
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Robu, C. B., I. M. Lupu, M. A. Docquier, M. Van Boven, and M. Momeni. "Medical utilization of Kiosk in the preoperative assessment of the ASA physical status: a pilot study." Acta Anaesthesiologica Belgica 75, no. 2 (2024): 117–23. http://dx.doi.org/10.56126/75.2.45.
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Background: The use of healthcare kiosk is increasing in the medical community. However, there are scares data on its use in a pre-operative clinic. Objective: The aim of this study is to validate an electronic questionnaire to assess the ASA physical status. Design: monocenter retrospective pilot study Setting: Tertiary hospital. Patients: 323 adults having a pre-operative visit prior to elective non-cardiac surgery. Main outcome measures: A questionnaire including 20 items (yes/no) was designed and inserted in the Kiosk. The ASA score was then retrospectively estimated by an anaesthesiologist not involved in preoperative visit, considering the total number of positive answers of the questionnaire inserted in the Kiosk. The answers to the questionnaire from the Kiosk were blinded to the anaesthesiologist performing the pre-operative face-to-face assessment. Agreement between both ASA scores provided from both anaesthesiologists was analysed using Cohen’s Kappa test (κ). Results: Agreement between ASA score estimated by kiosk answers and ASA score from face-to-face examination was substantially good with K=0.628 (P<0.001). Conclusion: Our electronic questionnaire is accurate in estimating patient’s physical status. A kiosk can be used to detect low risk patients in order to facilitate the preoperative assessment. However, it cannot replace a complete evaluation by a physician.
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Ruiz-García, Antonio, Óliver Jiménez, Davinia María Resurrección, Marco Ferreira, José Reis-Jorge, and Javier Fenollar-Cortés. "Portuguese validation of the Adult Separation Anxiety—Questionnaire (ASA-27)." PLOS ONE 16, no. 3 (2021): e0248149. http://dx.doi.org/10.1371/journal.pone.0248149.
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Adult separation anxiety disorder (ASAD) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Despite the high rates of this diagnosis among Portuguese adults, there is a lack of measures to assess it. In this study, we assessed the psychometric properties of a Portuguese adaptation of the Adult Separation Anxiety questionnaire (ASA-27) on a sample of 267 adults (72.7% women) aged 18–80 years (M = 40.5, SD = 13.1). Factor structure, internal consistency, and convergence validity were examined. This study confirmed the single-factor structure of the Portuguese version of ASA-27. Consistency was high for the total sample (ω = .92) and by gender (ω = .93 and 92, men and women groups, respectively). The scale was positively related to the Portuguese version of State-Trait Anxiety Inventory (STAI) (r = .57, p< .001, for both State and trait anxiety scales) and Composite Codependency Scale total score (r = .29, p< .001). In addition, the ASA-27 total score showed incremental validity in the explanation of anxiety measured by STAI. In conclusion, results show that the Portuguese version of the ASA-27 is a reliable and valid measure of ASAD.
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Kaplan, Svetlana, Alexander Kaplan, Karen F. Marcoe, William P. Hammond, Lloyd D. Fisher, and Lester R. Sauvage. "Citric Acid Enhances the Antithrombotic Effect of Aspirin in Many Aspirin-Resistant Subjects." Clinical and Applied Thrombosis/Hemostasis 3, no. 1 (1997): 54–57. http://dx.doi.org/10.1177/107602969700300108.
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This study had three objectives: (1) to determine the frequency of high platelet aggregators in a consecutive series of 268 apparently healthy volunteers who presented to our Center; (2) to assess the inhibitory effect of aspirin (ASA) on these high aggregators; (3) to determine, in a double-blind trial, whether or not the addition of citric acid (CTA) to ASA would increase its inhibitory effect in subjects who had a suboptimal response to aspirin alone. A platelet aggregation-scoring methodology developed for turbidimetric platelet aggregometry was used to quantify baseline aggregation and medicinal effects. We define a high aggregator as one whose unmedicated PA score is ≥30. We define the response of a high aggregator to ASA as poor if the medicated PA score stays at ≥30. We found that 58 of 268 apparently healthy unmedicated volunteers (22%) had PA scores ≥30. and that 27 of these (47%) had a poor response to 325 mg ASA, with an average drop in their PA scores from 49.5 ± 13.1 to 41.1 ± 8.6 (16%). Twenty-five of these 27 people were enrolled in the double-Mind study comparing the effect of ASA and ASA + CTA on platelet aggregability. Of these high aggregators who had a poor response to ASA, 12 of 25 (50%) had a good response to 162.5 mg of ASA plus 162.5 mg of CTA, with an average drop of their PA scores from 46.7 ± 13.2 to 22.0 ± 5.2 (53%). CTA alone had no effect on the PA score, which was similar to the control placebo. Our data suggest that a 1:1 combination of ASA and CTA may offer significantly greater protection agairtst arterial thrombotic events than ASA alone in subjects who respond poorly to ASA. Key Words: Platelet aggregation—Antithrombotic medication—Thrombosis.
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Konda, Sanjit R., Rown Parola, Cody Perskin, and Kenneth A. Egol. "ASA Physical Status Classification Improves Predictive Ability of a Validated Trauma Risk Score." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932198953. http://dx.doi.org/10.1177/2151459321989534.
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Introduction: The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of ASA physical status classification system to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population. Methods: A total of 1332 patients aged 55 years and older who sustained a hip fracture through a low-energy mechanism between October 2014 and February 2020 were included. The STTGMA and STTGMAASA mortality risk scores were calculated. The ability of the models to predict inpatient mortality was compared using area under the receiver operating characteristic curves (AUROCs) by DeLong’s test. Patients were stratified into minimal, low, moderate, and high risk cohorts based on their risk scores. Comparative analyses between risk score stratification distribution of mortality, complications, length of stay, ICU admission, and readmission were performed using Fisher’s exact test. Total cost of admission was fitted by univariate linear regression with STTGMA and STTGMAASA. Results: There were 27 inpatient mortalities (2.0%). When STTGMA was used, the AUROC was 0.742. When STTGMAASA was used, the AUROC was 0.823. DeLong’s test resulted in significant difference in predictive capacity for inpatient mortality between STTGMA and STTGMAASA (p = 0.04). Risk score stratification yielded significantly different distribution of all outcomes between risk cohorts (p < 0.01). STTGMAASA stratification produced a larger percentage of all negative outcomes with increasing risk cohort. Total hospital cost was statistically correlated with both STTGMAASA (p < 0.01) and STTGMA (p = 0.02). Conclusion: Including ASA physical status as a variable in STTGMA improves the model’s ability to predict inpatient mortality and risk stratify middle-aged and geriatric hip fracture patients.
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De Sanctis, Stefania, Raffaella Alonzo, Silvia Frontini, et al. "Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?" International Journal of Clinical Medicine 07, no. 12 (2016): 829–36. http://dx.doi.org/10.4236/ijcm.2016.712090.
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Coalson, D., M. F. Roizen, J. Apfelbaum, et al. "A1253 CORRELATION BETWEEN TWO PHYSICAL STATUS MEASURES AND THE ASA PHYSICAL STATUS SCORE." Anesthesiology 73, no. 3A (1990): NA. http://dx.doi.org/10.1097/00000542-199009001-01253.
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Le Teumier, Y., J. C. Rigal, K. Boulay, et al. "R394 Facteurs pronostiques pre et peroperatoires de mortalite en chirurgie digestive: Score asa ?" Annales Françaises d'Anesthésie et de Réanimation 17, no. 8 (1998): 1007. http://dx.doi.org/10.1016/s0750-7658(98)80510-8.
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Tran, Alexandre, Trinh Mai, Julie El-Haddad, et al. "Preinjury ASA score as an independent predictor of readmission after major traumatic injury." Trauma Surgery & Acute Care Open 2, no. 1 (2017): e000128. http://dx.doi.org/10.1136/tsaco-2017-000128.
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Kalhoro, Aurangzeb, and Abdul Sattar M. Hashim. "Advancing Lumbar Surgery: Exploring the Efficacy and Outcomes of Spinal Anesthesia in 41 Cases." International Journal of Endorsing Health Science Research (IJEHSR) 11, no. 2 (2023): 90–96. http://dx.doi.org/10.29052/ijehsr.v11.i2.2023.90-96.
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Background: Spinal anesthesia has emerged as a safe and effective alternative for patients with lumbar spine degenerative disease, particularly those with comorbidities. The aim of this study was to investigate the role of spinal anesthesia in the management of lumbar disc degeneration at the Neurospinal and Cancer Care Institute in Karachi.
 Methodology: This prospective cohort study was conducted at the Neurospinal and Cancer Care Institute's Department of Neurosurgery. The study included patients with a mean age of 53.43 ± 8.11 years and was carried out from February 2019 to August 2022, following approval from the Institutional Review Board.
 Results: The study comprised predominantly high-risk patients, with 32 individuals (78%) having associated comorbidities. The American Society of Anesthesiologists (ASA) classification was used to assess the patients' risk level, with 3 patients (7.31%) classified as ASA grade I, 21 patients (51.21%) as ASA grade II, 16 patients (39.02%) as ASA grade III, and 2 patients (4.87%) as ASA grade IV. The most commonly affected level of disc degeneration was L4-L5 (63.41%), followed by L5-S1 (36.58%), with the majority of stenosis occurring at L4-S1. No complications such as urinary retention, vomiting, or dural tear were observed. Pain relief was assessed using the visual analogue scale (VAS), with 23 patients having a preoperative VAS score of 7, 14 patients with a score of 8, and 4 patients with a score of 9. Postoperatively, 18 patients (43.9%) had a VAS score of 2, 23 patients (56%) had a score of 1, and 5 patients (12%) had a score of 0.
 Conclusion: Based on the findings of this study, spinal anesthesia can be considered a suitable alternative to general anesthesia for patients with comorbidities or those classified as ASA grade I/II. This technique offers several advantages, including cost-effectiveness, shorter anesthesia duration, and fewer complications. These findings support the use of spinal anesthesia in patients with limited spinal pathology in the lumbar spine.
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Ramchandra, Jangu, and Meena Raghuveer. "Evaluation of the Risk Factors Affecting Elderly Patients' Inability to Regain Pre-Fracture Mobility Following Hip Fracture Surgery." International Journal of Pharmaceutical and Clinical Research 16, no. 12 (2024): 112–14. https://doi.org/10.5281/zenodo.14590663.
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<strong>Background:</strong> Our aim in this study is to examine the effects of fracture type on restoring mobility in the postoperative period. <strong>Methods:</strong> In this observational study, 100 consecutive patients over the age of 65 who were admitted to the hospital with hip fractures were examined. Hospital digital records were examined and patients’ age, gender, body mass index (BMI), smoking, American Society of Anesthesiologists (ASA) score, comorbidities (cardiovascular, respiratory, renal, neurological diseases and malignancy), fracture type, type of implant used in surgery and Charlson comorbidity index score were recorded. <strong>Result:</strong> 100 patients were included in the study. 62 patients were female and 38 were male, with a mean age of 78.23±8.31 years. There 61 patients were intertrochanteric fractures and 39 were femoral neck fractures. 12 patients underwent proximal femoral nail (PFN), 72 patients underwent hemiarthroplasty, 13 patients underwent dynamic hip screw (DHS) and 3 patients underwent total hip arthroplasty. In the analysis performed to determine the level of mobility, it was found that 96 patients moved without the use of an aid and 4 patients moved with the use of an aid in the pre-fracture period. In the sixth month postoperative follow-up, it was observed that 61 patients were ambulated without the use of an aid, 25 patients were ambulated with the use of an aid, and 14 patients were immobile. <strong>Conclusion:</strong> Advanced age, high ASA score, cardiovascular disease or malignancy among comorbidities, intertrochanteric fracture as fracture type, and use of PFN as implant type were the main risk factors for not regain to pre-fracture mobility and ADL.
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Kolehmainen, Anne Maarit, Annukka Pasanen, Taru Tuomi, Riitta Koivisto-Korander, Ralf Butzow, and Mikko Loukovaara. "American Society of Anesthesiologists physical status score as a predictor of long-term outcome in women with endometrial cancer." International Journal of Gynecologic Cancer 29, no. 5 (2019): 879–85. http://dx.doi.org/10.1136/ijgc-2018-000118.
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ObjectiveTo study the association of the American Society of Anesthesiologists (ASA) physical status score with long-term outcome in endometrial cancer.MethodsOverall, disease-specific and non-cancer-related survival were estimated using simple and multivariable Cox regression analyses and the Kaplan-Meier method.ResultsA total of 1166 patients were included in the study. Median follow-up time was 76 (range 1–136) months. All-cause and non-cancer-related mortality were increased in patients whose ASA physical status score was III (HRs 2.5 and 8.0, respectively) or IV (HRs 5.7 and 25, respectively), and cancer-related mortality was increased in patients whose score was IV (HR 2.7). Kaplan-Meier analyses demonstrated a worse overall, disease-specific and non-cancer-related survival for patients whose score was ≥III (p<0.0001 for all). Disease-specific survival was also separately analyzed for patients with stage I and stage II–IV cancer. Compared with patients whose score was ≤II, the survival was worse for patients whose score was ≥III in both subgroups of stages (p=0.003 and p=0.017 for stage I and stages II–IV, respectively). ASA physical status score remained an independent predictor of all-cause mortality (HR 2.2 for scores ≥III), cancer-related mortality (HRs 1.7 and 2.2 for scores ≥III and IV, respectively) and non-cancer related mortality (HR 3.1 for scores ≥III) after adjustment for prognostically relevant clinicopathologic and blood-based covariates. ASA physical status score also remained an independent predictor of cancer-related mortality after exclusion of patients who were at risk for nodal involvement based on features of the primary tumor but who did not undergo lymphadenectomy, and patients with advanced disease who received suboptimal chemotherapy (HRs 1.6 and 2.5 for scores ≥III and IV, respectively).ConclusionsASA physical status score independently predicts overall survival, disease-specific survival, and non-cancer-related survival in endometrial cancer.
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Durán, Josefina, Christine Peloquin, Yuqing Zhang, and David T. Felson. "Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study." Journal of Rheumatology 44, no. 4 (2017): 418–24. http://dx.doi.org/10.3899/jrheum.160930.
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Objective.Subjects with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular disease, which is their leading cause of death. Conflicting evidence exists regarding the efficacy of aspirin (ASA) as primary prevention. We evaluated whether a protective association exists between ASA and myocardial infarction (MI) in RA subjects.Methods.In the United Kingdom, persons age ≥ 60 years receive free ASA by prescription and 75% of use is by prescription. Subjects ≥ 60 years with RA in the population-based The Health Improvement Network database constituted our study population. We excluded patients with history of MI, angina, stroke, peripheral vascular disease, or coronary artery procedures. Our main outcome was the occurrence of fatal and nonfatal MI. We performed a case-crossover study with each subject contributing a hazard period and a control period 90 days prior to the MI. In addition, to minimize confounding by indication, a propensity score (PS)–matched cohort study was performed, considering all patients with RA with an incident prescription of low-dose ASA as our exposed group.Results.We did not find a protective effect in the case-crossover study (OR 1.83, 95% CI 0.71–4.71), with 55 subjects exposed in the hazard period and 44 in the control period. Similarly, among 1836 subjects included in the PS-matched cohort study (918 ASA users and 918 ASA non-users), we did not find a protective effect of low ASA on MI (HR 1.39, 95% CI 0.87–2.23).Conclusion.We did not find a protective effect of ASA on MI in patients with RA when used as primary prophylaxis.
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Lip, Gregory, Jesper Lindhardsen, Deirdre Lane, et al. "Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a ‘real world’ nationwide cohort study." Thrombosis and Haemostasis 106, no. 10 (2011): 739–49. http://dx.doi.org/10.1160/th11-05-0364.
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SummaryIt was the aim of this study to determine the efficacy and safety of vitamin K antagonists (VKAs) and acetylsalicylic acid (ASA) in patients with non-valvular atrial fibrillation (AF), with separate analyses according to predicted thromboembolic and bleeding risk. By individual levellinkage of nationwide registries, we identified all patients discharged with non-valvular AF in Denmark (n=132,372). For every patient, the risk of stroke and bleeding was calculated by CHADS2, CHA2DS2-VASc, and HAS-BLED. During follow-up, treatment with VKA and ASA was determined time-dependently. VKA consistently lowered the risk of thromboembolism compared to ASA and no treatment; the combination of VKA+ASA did not yield any additional benefit. In patients at high thromboembolic risk, hazard ratios (95% confidence interval) for thromboembolism were: 1.81 (1.73–1.90), 1.14 (1.06–1.23), and 1.86 (1.78–1.95) for ASA, VKA+ASA, and no treatment, respectively, compared to VKA. The risk of bleeding was increased with VKA, ASA, and VKA+ASA compared to no treatment, the hazard ratios were: 1.0 (VKA; reference), 0.93 (ASA; 0.89–0.97), 1.64 (VKA+ASA; 1.55–1.74), and 0.84 (no treatment; 0.81–0.88), respectively. There was a neutral or positive net clinical benefit (ischaemic stroke vs. intracranial haemorrhage) with VKA alone in patients with a CHADS2 score of ≥ 0, and CHA2DS2-VASc score of ≥ 1. This large cohort study confirms the efficacy of VKA and no effect of ASA treatment on the risk of stroke/thromboembolism. Also, the risk of bleeding was increased with both VKA and ASA treatment, but the net clinical benefit was clearly positive, in favour of VKA in patients with increased risk of stroke/thromboembolism.
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Fitria, Wayan Eka, Siti Fatonah, and Purwati Purwati. "FAKTOR YANG BERHUBUNGAN DENGAN BROMAGE SCORE PADA PASIEN SPINAL ANASTESI DI RUANG PEMULIHAN." Jurnal Ilmiah Keperawatan Sai Betik 14, no. 2 (2019): 182. http://dx.doi.org/10.26630/jkep.v14i2.1304.
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<p><em>Bromage score</em> satu indikator respon motorik pasca spinal anastesi. spinal anastesi adalah metode anestesi dengan cara menyuntikkan obat analgetik lokal kedalam ruang subarachnoid di daerah lumbal. Penilaian status fisik (ASA) didapat rata-rata waktupencapaianskalaBromage 2 padapasien ASA I adalah 184,75menitdanrespondenpasien ASA II 207 menit. Di salah satu rumah sakit di Bandar Lampung pasien pasca operasi dengan spinal anastesi respon motorik terbesar adalah &lt; 4 jam (62,5) responden. Rancangan penelitian<em>survey analitik</em>dengan pendekatan <em>cross sectional</em>. Teknik pengambian sampel menggunakan teknik <em>accidental sampling</em>. Populasi adalah pasien pasca spinal anastesi di ruang pemulihan sebuah rumah sakit di Bandar Lampung dengan jumlah sampel 33 responden. Pengumpulan data menggunakan lembar observasi dengan menggunakan uji <em>Chi Square</em>. Hasil penelitian didapatkan adanya dua faktor yang berhubungan dengan <em>bromage score </em>yaitu status fisik ASA dengan nilai <em>value </em>= 0,000 sedangkan nilai OR=105,00 (9,932 - 1110.017) dan Umur dengan nilai <em>value </em>= 0,001 sedangkan nilai OR=14.000 (2,539 -77,208). Sedangkan yang tidak berhubungan yaitu faktor posisi pembedahan dengan nilai <em>value </em>=0,665. Peneliti berharap agar fakto-faktor yang dapat mempengaruhi <em>bromage score </em>pasien spinal anastesi tetap diperhatikan agar tidak terjadi komplikasi pasien pasca spinal anastesi.</p>
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Weitgasser, Laurenz, Amro Amr, Michaela Hladik, et al. "The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients." Journal of Reconstructive Microsurgery 35, no. 06 (2019): 395–410. http://dx.doi.org/10.1055/s-0038-1677455.
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Background The need for plastic and reconstructive surgery on elderly patients has been on the rise due to an increase in life expectancy in the past decades. Therefore, a study was conducted on young and elderly patients following microsurgical extremity reconstructions with free gracilis muscle flaps with the primary aim to investigate the influence of age and the American Society of Anesthesiologists (ASA) score on the general outcome, as well as surgical and medical complications. Methods A retrospective analysis of 153 patients receiving free gracilis muscle flaps for extremity reconstructions between November 2009 and January 2018 was performed at two partner institutions specialized in microsurgical reconstructions. A logistic regression analysis was performed to correlate age and the ASA score with postoperative complication probability. Patients younger than 70 years were directly compared with elderly patients with respect to age, gender, ASA score, preexisting comorbidities, localization, and postoperative medical and surgical complications. Results Age turned out to be not significantly associated with major flap complications (p = 0.925) but with higher ASA scores (p = 0.016). However, an age-related significant increase in minor flap complications could be observed in the elderly (p = 0.008). A significant correlation between minor medical complications and age could be observed (p = 0.001) in contrast to ASA score (p = 0.912). Conclusion An increased minor flap, as well as minor and major medical complications, must be expected in extremity reconstructions with free gracilis flaps in elderly patients. Higher ASA scores correlate with a higher incidence of major flap complications. Septuagenarians are more prone to develop perioperative major medical complications than patients younger than 70 years. Age and general medical condition, coupled with the performance of each patient, should be thoroughly assessed individually to facilitate a tailored reconstructive approach using risk assessment tools and established scoring systems.
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Gemma, Marco, Fulvia Pennoni, Roberta Tritto, and Massimo Agostoni. "Risk of adverse events in gastrointestinal endoscopy: Zero-inflated Poisson regression mixture model for count data and multinomial logit model for the type of event." PLOS ONE 16, no. 6 (2021): e0253515. http://dx.doi.org/10.1371/journal.pone.0253515.
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Background and aims We analyze the possible predictive variables for Adverse Events (AEs) during sedation for gastrointestinal (GI) endoscopy. Methods We consider 23,788 GI endoscopies under sedation on adults between 2012 and 2019. A Zero-Inflated Poisson Regression Mixture (ZIPRM) model for count data with concomitant variables is applied, accounting for unobserved heterogeneity and evaluating the risks of multi-drug sedation. A multinomial logit model is also estimated to evaluate cardiovascular, respiratory, hemorrhagic, other AEs and stopping the procedure risk factors. Results In 7.55% of cases, one or more AEs occurred, most frequently cardiovascular (3.26%) or respiratory (2.77%). Our ZIPRM model identifies one population for non-zero counts. The AE-group reveals that age >75 years yields 46% more AEs than age <66 years; Body Mass Index (BMI) ≥27 27% more AEs than BMI <21; emergency 11% more AEs than routine. Any one-point increment in the American Society of Anesthesiologists (ASA) score and the Mallampati score determines respectively a 42% and a 16% increment in AEs; every hour prolonging endoscopy increases AEs by 41%. Regarding sedation with propofol alone (the sedative of choice), adding opioids to propofol increases AEs by 43% and adding benzodiazepines by 51%. Cardiovascular AEs are increased by age, ASA score, smoke, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Respiratory AEs are increased by BMI, ASA and Mallampati scores, emergency, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. Hemorrhagic AEs are increased by age, in-hospital, procedure duration, midazolam/fentanyl associated with propofol. The risk of suspension of the endoscopic procedure before accomplishment is increased by female gender, ASA and Mallampati scores, and in-hospital, and it is reduced by emergency and procedure duration. Conclusions Age, BMI, ASA score, Mallampati score, in-hospital, procedure duration, other sedatives with propofol increase the risk for AEs during sedation for GI endoscopy.
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Kohring, Jessica M., Jeffrey R. Houck, Sam Flemister, John P. Ketz, Irvin Oh, and Judith F. Baumhauer. "Are Sicker Patients Less Likely to Improve after Ankle Fusion?" Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0025. http://dx.doi.org/10.1177/2473011419s00252.
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Category: Ankle Arthritis Introduction/Purpose: The influence of pre-existing medical conditions on post-operative patient reported outcomes are important to consider when selecting and preparing a patient for surgery. The purpose of this study was to determine the impact of medical comorbidities on post-operative physical function and pain in patients undergoing ankle arthrodesis. Methods: This was a Global IRB approved retrospective review of 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS PF and PI computerized adaptive test. A chart review was performed to determine the Charlson Comorbidities Index (CCI), ASA scores, and demographic data. A multivariate analysis predicting pre- and post-operative PROMIS PF based on PI, ASA score, and CCI was performed. Spearman correlations for CCI, ASA, pre- and post-operative PROMIS T- scores for PF and PI were calculated. Results: The ASA score and CCI were not associated with pre-operative PI, although the CCI was predictive of pre-operative physical function (p=0.06), indicating that patients with a higher CCI had lower pre-operative PF. Pre-operative PF and ASA were the best individual predictors of physical function at 6 months post-operatively (r=0.51). At 6 months after undergoing ankle arthrodesis, there was no correlation between CCI and post-operative PROMIS PF and PI outcome T-scores (r=0.02, r=-0.06, respectively), this continued at 1 year post-operatively (r=-0.17, r=0.04, respectively). Demographic data, ASA, CCI, and mean PROMIS T-scores are included in Table 1. Conclusion: Sicker patients (ASA score=3) and those with lower pre-operative function recovered more slowly as indicated by lower physical function at 6 months and obtained less physical function benefit from ankle fusion than healthier patients at one year. The results of this study can assist surgeons with risk stratification and educating patients about surgical expectations as pre- operative physical function and ASA score appear to influence post-operative physical function after undergoing ankle arthrodesis.
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Trigueros-Larrea, Jose Maria, Maria Antonia Gonzalez-Bedia, Jose Maria Lomo-Garrote, Oscar Martin-de la Cal, and Miguel Angel Martin-Ferrero. "Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?" Geriatrics 6, no. 3 (2021): 67. http://dx.doi.org/10.3390/geriatrics6030067.
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Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.
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Cher, Eric Wei Liang, John Allen Carson, Eileen Yilin Sim, Hairil Rizal Abdullah, Tet Sen Howe, and Joyce, Koh Suang Bee. "Developing a Simpler Prognosticating Tool: Comparing the Combined Assessment of Risk Encountered in Surgery Score with Deyo-Charlson Comorbidity Index and The American Society of Anesthesiologists Physical Status Score in Predicting 2 years Mortality after Hip Fracture Surgery." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 2021): 215145932110362. http://dx.doi.org/10.1177/21514593211036235.
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Background: The use of risk stratification tools in identifying high-risk hip fracture patients plays an important role during treatment. The aim of this study was to compare our locally derived Combined Assessment of Risk Encountered in Surgery (CARES) score with the the American Society of Anesthesiologists physical status (ASA-PS) score and the Deyo–Charlson Comorbidity Index (D-CCI) in predicting 2-year mortality after hip fracture surgery. Methods and Material: A retrospective study was conducted on surgically treated hip fracture patients in a large tertiary hospital from Jan 2013 through Dec 2015. Age, gender, time to surgery, ASA-PS score, D-CCI, and CARES score were obtained. Univariate and multivariable logistic regression analyses were used to assess statistical significance of scores and risk factors, and area under the receiver operating characteristic (ROC) curve (AUC) was used to compare ASA-PS, D-CCI, and CARES as predictors of mortality at 2 years. Results: 763 surgically treated hip fracture patients were included in this study. The 2-year mortality rate was 13.1% (n = 100), and the mean ± SD CARES score of surviving and demised patients was 21.2 ± 5.98 and 25.9 ± 5.59, respectively. Using AUC, CARES was shown to be a better predictor of 2-year mortality than ASA-PS, but we found no statistical difference between CARES and D-CCI. A CARES score of 23, attributable primarily to pre-surgical morbidities and poor health of the patient, was identified as the statistical threshold for “high” risk of 2-year mortality. Conclusion: The CARES score is a viable risk predictor for 2-year mortality following hip fracture surgery and is comparable to the D-CCI in predictive capability. Our results support the use of a simpler yet clinically relevant CARES in prognosticating mortality following hip fracture surgery, particularly when information on the pre-existing comorbidities of the patient is not immediately available.
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MANZOTTI, A., M. COLIZZI, D. BRIOSCHI, P. CERVERI, M. M. LARGHI, and M. GRASSI. "Preoperative infection risk assessment in hip arthroplasty a matched-pair study of the reliability of 3 validated risk scales." Acta Orthopaedica Belgica 89, no. 4 (2023): 613–18. http://dx.doi.org/10.52628/89.4.10486.
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Peri-prosthetic infection (PJI) represents one of the most devastating complications of total hip arthroplasty (THA). The aim of this study is to assess the reliability of different PJI risk assessment scales between two matched pairs of THA groups. This study included 37 patients with PJI following THA performed between 2012 and 2020 (Group A). Each patient in this group was matched, based on sex, age, and follow-up duration, with a control patient who underwent the same surgical procedure without any septic complications (Group B) during the same period. Each patient’s assessment included the American Society of Anesthesiologists (ASA) score and a retrospective evaluation using three different preoperative, specific PJI risk assessment scales: the International Consensus Meeting (ICM) Preoperative Risk Calculator for PJI, the Mayo PJI Risk Score, and the KLIC-score. The two groups were statistically compared using descriptive analyses, both for binomial data and numerical variables. Statistically significant higher values were observed in the preoperative ASA score and surgical time in Group A. Statistically different higher scores were determined only with the ICM risk calculator score in Group A. No significant differences were found using the KLIC score and Mayo score between the two groups. We emphasize the reliability of the ASA score as a nonspecific preoperative assessment scale for PJI. The ICM risk calculator was confirmed as a reliable, specific preoperative assessment scale for PJI, suggesting its routine adoption in THA clinical practice.
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Mrad, Mohamed Amir, Abdullah A. Al Qurashi, Qutaiba N. M. Shah Mardan, et al. "Venous Thromboembolism Risk Assessment Models in Plastic Surgery: A Systematic Review and Meta-Analysis." Plastic and Reconstructive Surgery - Global Open 10, no. 12 (2022): e4683. http://dx.doi.org/10.1097/gox.0000000000004683.
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Background: Postoperative venous thromboembolism (VTE) is the most common complication of plastic surgery procedures. Diverse risk assessment models (RAMs) exist to stratify patients by VTE risk, but due to a lack of high-quality evidence and heterogeneity in RAM data, there is no recommendation regarding RAM that can be used for plastic surgery patients. This study compares the reliability and outcomes of Caprini and American Society of Anesthesiologists (ASA) physical status classification RAMs used in plastic surgery to help surgeons stratify the risk of VTE. Methods: MEDLINE and Embase databases were searched between February 2010 and December 2021. All published English articles that report the incidence of VTE stratified by a RAM among patients who underwent plastic surgery were included. The results of the presented meta-analysis were pooled using a random-effects model. Results: The database search revealed 809 articles, out of which eight studies (n = 1,348,606) were eligible. Out of the eight studies, six utilized the Caprini score, and three utilized ASA score. Super-high-risk patients were significantly more likely to present with VTE than their high-risk [odds ratio (OR), 2.92; 95% confidence interval (CI), 1.26–6.78], medium-risk (OR, 5.29; 95% CI, 2.38–11.79), or low-risk counterparts (OR, 10.00; 95% CI, 2.32–43.10) at Caprini score. High-risk patients in ASA score showed significant increase in VTE incidents (OR, 2.72; 95% CI, 1.10–6.72). Conclusions: Both Caprini and ASA RAMs showed compelling evidence of efficacy in our study. However, the Caprini RAM is more predictive of postoperative VTE incidents in high-risk plastic surgery patients than the ASA grading system.
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van Praag, Veroniek M., Dominique Molenaar, Guus A. H. Tendijck, et al. "The Importance of Patient Systemic Health Status in High-Grade Chondrosarcoma Prognosis: A National Multicenter Study." Cancers 16, no. 20 (2024): 3484. http://dx.doi.org/10.3390/cancers16203484.
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Background: Due to the relatively advanced age and high mortality rate of patients with high-grade chondrosarcoma (CS), it is important to holistically assess patient- and tumor characteristics in multidisciplinary team and shared decision-making with regard to treatment options. While current prognostic models include multiple tumor and treatment characteristics, the only patient characteristics that are commonly included are age and gender. Based on clinical experience, we believe that factors related to patient preoperative systemic health status such as the American Society of Anesthesiologists (ASA) score may be equally important prognostic factors for overall survival (OS). Methods: A retrospective nationwide cohort study was identified from four specialized bone sarcoma centers in The Netherlands. Patients with a primary CS grade II, III, and dedifferentiated CS were eligible. Prognostic factors including age at presentation, gender, ASA score, CVD, tobacco use, BMI, histological tumor grade, tumor size, pathological fracture, presentation after unplanned excision, type of surgery and surgical margin were evaluated. The outcome measure was OS at the time of surgery. The Kaplan–Meier methodology was employed to estimate OS; a log-rank test was used to assess the difference in survival. To study the impact of prognostic factors on OS, a multivariate Cox proportional hazard regression model was estimated. Results: In total, 249 patients were eligible for this study, and 89 were deceased at the end of follow-up. In multivariate analysis, histological grade (HR 2.247, 95% CI 1.334–3.783), ASA score III (HR 2.615, 95% CI 1.145–5.976, vs. ASA I), and age per year (HR: 1.025, 95% CI 1.004–1.045) were negatively associated with OS. No association was found between tobacco use, BMI, gender or cardiovascular disease and OS in this cohort. Pathological fracture and tumor size were only associated with OS in univariate analysis. Conclusions: This multicenter study is the first on sarcomas to include ASA in a prognostic model. Results show that ASA score as a proxy for patients’ systemic health status should be included when providing a prognosis for patients with a high-grade primary CS, besides the conventional risk factors such as tumor grade and age. Specifically, severe systemic disease (ASA score III) is a strong negative predictor. Conversely, we found no difference in OS between ASA scores I and II. These findings aid multidisciplinary team and shared decision-making with regard to these complex sarcoma patients that often require life-changing surgeries. Level of Evidence: Prognostic level III. See the instructions for authors for the complete description of levels of evidence.
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Rismawati, Tophan Heri Wibowo, and Arlyana Hikmanti. "ANALISIS FAKTOR-FAKTOR YANG BERPENGARUH TERHADAP PEMULIHAN BROMAGE SCORE PASIEN PASCA ANESTESI SPINAL DI RUMAH SAKIT KHUSUS BEDAH JATIWINANGUN." Jurnal Cakrawala Ilmiah 2, no. 12 (2023): 4485–96. http://dx.doi.org/10.53625/jcijurnalcakrawalailmiah.v2i12.6384.
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Suatu blok neuraksial yang disebut anestesi spinal terjadi ketika obat anestesi lokal atau ajuvan dimasukkan ke rongga subarachnoid. Hal ini dapat menghilangkan sensasi dan memblokir fungsi motorik. Setelah anestesi spinal diruang pemulihan, motorik pasien dinilai dengan bromage score. Ada faktor-faktor yang memengaruhi waktu pemulihan, kecemasan dan gangguan neurologis seperti paratesi muncul sebagai akibat pemulihan yang lama. Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor yang berpengaruh terhadap pemulihan bromage score pasien pasca anestesi spinal di Rumah Sakit Khusus Bedah Jatiwinangun. Penelitian ini menggunakan metode deskriptif korelasional dengan pendekatan cross-sectional. Penelitian ini melibatkan 65 responden, dan data dikumpulkan melalui lembar observasi. Hasil penelitian menunjukkan bahwa status fisik ASA memiliki nilai ρ value 0,000 < α 0,05, dan nilai uji corelasi coefficient=0,763 menunjukkan keeratan hubungan sedang dan korelasi positif. Usia memiliki nilai ρ value 0,000 < α 0,05, dan nilai uji corelasi coefficient=0,873 menunjukkan keeratan hubungan kuat dan korelasi positif. Untuk jenis kelamin nilai ρ value 0,033 < α 0,05, dan nilai uji Contingensi Coefficient=0,256. Kesimpulan pemulihan bromage score pasien pasca anestesi spinal di Rumah Sakit Khusus Bedah Jatiwinangun dipengaruhi oleh status fisik ASA, usia, dan jenis anestesi