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American Society of Anesthesiologists classification in cataract surgery: Results from the Ophthalmic Surgery
Abhishek R Payal1, David Sola-Del Valle1, Luis A Gonzalez-Gonzalez1
1From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
Purpose:
To explore the association of American Society of Anesthesiologists (ASA) classification with cataract surgery outcomes.
Setting:
Five Veterans Affairs Medical Centers, United States.
Design:
Retrospective observational cohort study.
Methods:
The study analyzed the outcomes of cataract surgery cases. Corrected distance visual acuity (CDVA), unanticipated events, and vision-related quality of life (VRQL) were assessed using the National Eye Institute Visual Function Questionnaire (NEI-VFQ), comparing ASA classes I through IV. For some analyses, ASA classes I and II were designated as Group A and ASA classes III and IV were designated Group B.
Results:
Of the 4923 cases, 875 (17.8%) were in Group A, 4032 (81.9%) were in Group B, and 16 (0.3%) had missing data. The mean CDVA and mean composite NEI-VFQ score improved after cataract surgery in both groups (P < .0001); however, Group A had a better mean postoperative CDVA and postoperative VFQ composite scores than Group B (P < .0001, both outcomes). A higher ASA class was associated with an increased risk for 2 unanticipated events; that is, clinically significant macular edema (CSME) (Group A: 4 [0.47%] versus Group B: 50 [1.28%]; adjusted odds ratio [OR], 3.02; 95% confidence interval [CI], 1.02-13.05; P = 0.04) and readmission to the hospital within 30 days (2 [0.23%] versus 56 [1.41%]; OR, 8.26; 95% CI, 1.71-148.62; P = .004) CONCLUSIONS: Among United States veterans, the ASA classification could be an important predictor of VRQL and visual outcomes. In this cohort, it was associated with an increased risk for 2 serious unanticipated events-CSME and readmission to the hospital-both costly, unwanted outcomes.
Financial Disclosure:
Dr. Vollman is a consultant to Forsight Vision5. None of the authors has a financial or proprietary interest in any material or method mentioned.
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