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Deaths in Incorrectly Identified Low-Surgical-Risk Patients.

C R Jones1, G A J McCulloch2, G Ludbrook2

  • 1Royal Australasian College of Surgeons, ANZASM, Adelaide, Australia. charles.jones@student.adelaide.edu.au.

World Journal of Surgery
|January 5, 2018
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Summary
This summary is machine-generated.

The American Society of Anesthesiologists (ASA) physical classification system is often misused, with over 95% of low-grade patients incorrectly classified. This indicates a misunderstanding of ASA grades in assessing surgical risk and predicting patient outcomes.

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Area of Science:

  • Anesthesiology
  • Surgical Risk Assessment
  • Patient Safety

Background:

  • The American Society of Anesthesiologists (ASA) physical classification system is primarily for anesthetic risk but often used for surgical death risk.
  • Lower ASA grades (1 or 2) typically correlate with better surgical outcomes compared to higher grades (≥4).
  • This study investigates unexpected deaths in patients with low ASA grades (1 or 2) to identify contributing factors and assess clinician use of ASA grading.

Purpose of the Study:

  • To examine the accuracy of ASA grade assignments in patients with low grades (1 or 2).
  • To investigate factors contributing to unexpected deaths in this patient cohort.
  • To evaluate the clinical application and understanding of the ASA physical classification system.

Main Methods:

  • Analysis of patient data from the Australian national surgical mortality audit.
  • Inclusion of patients initially classified as ASA grade 1 or 2 by surgeons.
  • Exclusion of patients aged under 20 or over 60, and cases from New South Wales; reassessment of ASA scores by expert assessors.

Main Results:

  • Over 95% of cases designated as ASA 1 or 2 were found to have an inaccurately low grade.
  • Approximately 17.6% of these cases were identified as "expected" deaths, despite their low ASA classification.
  • Significant discrepancies highlight potential misinterpretation of the ASA grading system.

Conclusions:

  • Clinician understanding and application of ASA grades for surgical risk assessment appear to be flawed.
  • Patients with severe systemic disease or expected mortality are sometimes incorrectly assigned low ASA grades (1 or 2).
  • Enhanced education on the appropriate use of the ASA classification system is recommended for healthcare professionals.