Four questions to identify patients with ASA III or higher

Area of Science:

• Anesthesiology
• Perioperative Medicine
• Health Services Research

Background:

• Patient mortality and perioperative complications are linked to advanced age, obesity, and high American Society of Anesthesiologists (ASA) Physical Status classes III and IV.
• High-volume medical institutions utilize central referral services as the primary patient contact point.
• Current referral processes may benefit from enhanced patient stratification for optimized perioperative management.

Purpose of the Study:

• To introduce and validate a straightforward four-step questionnaire for identifying patients with ASA Physical Status class III and IV.
• To improve the efficiency and accuracy of patient referrals and perioperative evaluations.
• To facilitate better resource allocation and patient management in busy clinical settings.

Main Methods:

• A cohort of 775 patients referred through a physician referral service (PRS) and subsequently undergoing surgery was analyzed.
• Data from the initial PRS questionnaire were retrospectively examined.
• Patient demographics included 53.4% women and 46.6% men, with an average age of 61.4 years.

Main Results:

• Logistic regression identified hypertension, diabetes mellitus (on medication), use of blood thinners (excluding aspirin), and 4-9 prescribed medications as predictors for ASA III/IV status.
• A receiver-operating characteristic (ROC) curve analysis demonstrated 82.8% accuracy when two of the four questionnaire items were positive.
• The area under the ROC curve was 0.876, indicating strong predictive performance.

Conclusions:

• A concise, four-step questionnaire can effectively screen for patients with ASA III or IV status prior to medical appointments.
• This screening tool can help balance patient referrals across providers in large medical groups.
• Implementing this questionnaire can streamline the referral process and improve perioperative care planning.